Session: MP31: Renal Transplantation & Vascular Surgery I
MP31-11: Duration of the agonal phase does not impact delayed graft function nor one-year renal function in donation after circulatory death kidney transplantation.
Introduction: Donation after circulatory death (DCD) has significantly expanded the limited pool of available kidney allografts. The agonal phase is measured between the withdrawal of life-sustaining treatment and the time of circulatory arrest. Due to concerns about ischemic kidney injury during the agonal phase, many transplant programs use a cut-off time of 1 hour before abandoning the kidney retrieval. Our centre may use kidneys with an agonal phase for up to 3 hours. We evaluated how the length of the agonal phase influences graft outcomes. Methods: We analysed a single-centre database of DCD renal transplant recipients between 2006-2020. Pediatric and donation after euthanasia donors were excluded. Data collected included recipient and donor demographics, surgery information, and outcomes up to one-year post transplant. SPSS was used for statistical analysis. Results: Of the 182 DCD kidney donations that were identified, 27 (14.8%) arrested after 1 hour, and 10 (5.5%) arrested after 1.5 hours. The mean agonal time was 25 minutes. The longest interquartile range was between 37 and 130 minutes. Binary logistic regression showed no significant association between time to arrest and delayed graft function (DGF) (p=0.79) or primary nonfunction (PNF) (p=0.50). The Chi-square test also showed no significant association between DGF or PNF and donors who arrested in the longest quartile (X2=0.17, p=0.67), after 1 hour (X2=0.611, p=0.44), or after 1.5 hours (X2=0.161, p=0.69). Pearson correlation did show a weak association between time to arrest and a higher creatinine at three months (0.245, p=0.002) and six months (0.177, p=0.043), but this association was no longer present at one year (-0.032, p=0.77). Conclusions: We found no association between the length of the agonal phase and DGF or one-year renal function after transplantation. This supports the use of kidneys from DCD donors with agonal phases of one hour and beyond. SOURCE OF Funding: No disclosures.
