Kidney transplant utilising donors after circulatory death: The first report from the African continent
Background. At Groote Schuur Hospital in Cape Town, South Africa, the number of deceased organ donors has declined over the past 2 decades, necessitating a more liberal approach to donor selection. In 2007, measures to expand the deceased kidney donor pool were implemented, including an HIV pos...
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South African Medical Association
2024-04-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/1369 |
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| author | T du Toit K Manning L Bertels G Hoffman D Thomson Z A Barday |
| author_facet | T du Toit K Manning L Bertels G Hoffman D Thomson Z A Barday |
| author_sort | T du Toit |
| collection | DOAJ |
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Background. At Groote Schuur Hospital in Cape Town, South Africa, the number of deceased organ donors has declined over the past 2 decades, necessitating a more liberal approach to donor selection. In 2007, measures to expand the deceased kidney donor pool were implemented, including an HIV positive-to-positive transplant programme and the utilisation of extended-criteria donors as well as donors after circulatory death (DCDs).
Objectives. To report on our institutional experience with DCD kidney transplants and to encourage this approach among other African centres to improve access to transplantation.
Methods. An observational cohort study of consecutive DCD kidney transplants at Groote Schuur Hospital over a 17-year period was performed. Primary endpoints were 1-, 2- and 5-year graft and patient survival. Secondary endpoints included the incidence of delayed graft function (DGF), 30-day morbidity, length of stay, and donor and recipient clinical characteristics.
Results. Fifteen DCD procurements were performed, with no kidneys discarded. Thirty kidney transplants were performed, with a median (interquartile range) cold ischaemic time of 11.5 (8 - 14) hours. The incidence of DGF was 60.0%, and 30-day morbidity (other than DGF) was 20.0%. Graft survival at 1, 2 and 5 years was 100%, 96.0% and 73.7%, respectively. Patient survival at 1, 2 and 5 years was 93.3%, 93.3% and 88.4%, respectively.
Conclusion. Long-term graft and patient survival was comparable with the international literature. DCD may present a unique opportunity to expand deceased donation throughout Africa, particularly in areas affected by a lack of brain death legislation and religious or cultural objections to donation after brain death.
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| format | Article |
| id | doaj-art-b34ee245637743ff950ce182fa167f89 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-b34ee245637743ff950ce182fa167f892025-02-10T12:26:11ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-04-011143b10.7196/SAMJ.2024.v114i3b.1369Kidney transplant utilising donors after circulatory death: The first report from the African continentT du Toit0K Manning1L Bertels2G Hoffman3D Thomson4Z A Barday5Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDivision of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDivision of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa Division of Critical Care, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa Division of Critical Care, Department of Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDivision of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa Background. At Groote Schuur Hospital in Cape Town, South Africa, the number of deceased organ donors has declined over the past 2 decades, necessitating a more liberal approach to donor selection. In 2007, measures to expand the deceased kidney donor pool were implemented, including an HIV positive-to-positive transplant programme and the utilisation of extended-criteria donors as well as donors after circulatory death (DCDs). Objectives. To report on our institutional experience with DCD kidney transplants and to encourage this approach among other African centres to improve access to transplantation. Methods. An observational cohort study of consecutive DCD kidney transplants at Groote Schuur Hospital over a 17-year period was performed. Primary endpoints were 1-, 2- and 5-year graft and patient survival. Secondary endpoints included the incidence of delayed graft function (DGF), 30-day morbidity, length of stay, and donor and recipient clinical characteristics. Results. Fifteen DCD procurements were performed, with no kidneys discarded. Thirty kidney transplants were performed, with a median (interquartile range) cold ischaemic time of 11.5 (8 - 14) hours. The incidence of DGF was 60.0%, and 30-day morbidity (other than DGF) was 20.0%. Graft survival at 1, 2 and 5 years was 100%, 96.0% and 73.7%, respectively. Patient survival at 1, 2 and 5 years was 93.3%, 93.3% and 88.4%, respectively. Conclusion. Long-term graft and patient survival was comparable with the international literature. DCD may present a unique opportunity to expand deceased donation throughout Africa, particularly in areas affected by a lack of brain death legislation and religious or cultural objections to donation after brain death. https://samajournals.co.za/index.php/samj/article/view/1369kidney transplantDeath certificationPalliative careSouth Africa |
| spellingShingle | T du Toit K Manning L Bertels G Hoffman D Thomson Z A Barday Kidney transplant utilising donors after circulatory death: The first report from the African continent South African Medical Journal kidney transplant Death certification Palliative care South Africa |
| title | Kidney transplant utilising donors after circulatory death: The first report from the African continent |
| title_full | Kidney transplant utilising donors after circulatory death: The first report from the African continent |
| title_fullStr | Kidney transplant utilising donors after circulatory death: The first report from the African continent |
| title_full_unstemmed | Kidney transplant utilising donors after circulatory death: The first report from the African continent |
| title_short | Kidney transplant utilising donors after circulatory death: The first report from the African continent |
| title_sort | kidney transplant utilising donors after circulatory death the first report from the african continent |
| topic | kidney transplant Death certification Palliative care South Africa |
| url | https://samajournals.co.za/index.php/samj/article/view/1369 |
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