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Controlled donation after circulatory death using normothermic regional perfusion does not increase graft fibrosis in the first year posttransplant surveillance biopsy

Abstract: Objectives: The number of kidney transplants obtained from controlled donations after circulatory death is increasing, with long-term outcomes similar to those obtained with donations after brain death. Extraction using normothermic regional perfusion can improve results with controlled donors after circulatory death; however, information on the histological impact and extraction procedure is scarce. Materials and methods: We retrospectively investigated all kidney transplants performed from October 2014 to December 2019, in which a follow-up kidney biopsy had been performed at 1-year follow-up, comparing controlled procedures with donors after circulatory death and normothermic regional perfusion versus donors after brain death. Interstitial fibrosis/tubular atrophy was assessed by adding the values of interstitial fibrosis and tubular atrophy, according to the Banff classification of renal allograft pathology. Results: When we compared histological data from 66 transplants with donations after brain death versus 24 transplants with donations after circulatory death and normothermic regional perfusion, no differences were found in the degree of fibrosis in the 1-year follow-up biopsy (1.7 ± 1.3 vs 1.7 ± 1.1; P = .971) or in the ratio of patients with increased fibrosis calculated as interstitial fibrosis/tubular atrophy >2 (18% vs 13%; P = .522). In our multivariate analysis, which included acute rejection, expanded criteria donation, and the type of donation, no variable was independently related to an increased risk of interstitial fibrosis/tubular atrophy >2. Conclusions: The outcomes of kidney grafts procured in our center using controlled procedures with donors after circulatory death and normothermic regional perfusion were indistinguishable from those obtained from donors after brain death, showing the same degree of fibrosis in the 1-year posttransplant surveillance biopsy. Our data support the conclusion that normothermic regional perfusion should be the method of choice for extraction in donors after circulatory death.

 Autoría: Barreda P., Miñambres E., Ballesteros M.Á., Mazón J., Gómez-Román J., Ortega J.M.G., Belmar L., Valero R., Ruiz J.C., Rodrigo E.,

 Fuente: Experimental and Clinical Transplantation, 2022, 12, 1069-1075

 Editorial: Baskent University

 Año de publicación: 2022

 Nº de páginas: 7

 Tipo de publicación: Artículo de Revista

 DOI: 10.6002/ECT.2022.0171

 ISSN: 1304-0855,2146-8427

 Proyecto español: RICORS2040

 Url de la publicación: https://doi.org/10.6002/ECT.2022.0171

Autoría

BARREDA, PALOMA

MARIA ANGELES BALLESTEROS SANZ

MAZÓN, JAIME

GÓMEZ ORTEGA, JOSÉ MARÍA

LARA BELMAR VEGA

ROSALIA MARIA VALERO SAN CECILIO