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Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death

1
Department of Infection, Immunity and Inflammation, University of Leicester, University Road, Leicester LE1 7RH, UK
2
Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
3
School of Medicine, University of Leicester, University Road, Leicester LE1 7RH, UK
4
Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
5
Department of Cardiovascular Sciences, University of Leicester, University Hospitals of Leicester, Leicester LE1 7RH, UK
*
Author to whom correspondence should be addressed.
Department of Infection, Immunity and Inflammation now renamed as Department of Respiratory Sciences.
Medicina 2020, 56(6), 317; https://doi.org/10.3390/medicina56060317
Received: 13 May 2020 / Revised: 17 June 2020 / Accepted: 18 June 2020 / Published: 26 June 2020
Background and objectives: Kidneys from donation after circulatory death (DCD) are more likely to be declined for transplantation compared with kidneys from donation after brain death (DBD). The aim of this study was to evaluate characteristics in the biopsies of human DCD and DBD kidneys that were declined for transplantation in order to rescue more DCD kidneys. Materials and Methods: Sixty kidney donors (DCD = 36, DBD = 24) were recruited into the study and assessed using donor demographics. Kidney biopsies taken post cold storage were also evaluated for histological damage, inflammation (myeloperoxidase, MPO), von Willebrand factor (vWF) expression, complement 4d (C4d) deposition and complement 3 (C3) activation using H&E and immunohistochemistry staining, and Western blotting. Results: More DBD donors (16/24) had a history of hypertension compared with DCDs (8/36, p = 0.001). The mean warm ischemic time in the DCD kidneys was 12.9 ± 3.9 min. The mean cold ischemic time was not significantly different between the two groups of kidney donors (DBD 33.3 ± 16.7 vs. DCD 28.6 ± 14.1 h, p > 0.05). The score of histological damage and MPO, as well as the reactivity of vWF, C4d and C3, varied between kidneys, but there was no significant difference between the two donor types (p > 0.05). However, vWF reactivity might be an early indicator for loss of tissue integrity, while C4d deposition and activated C3 might be better predictors for histological damage. Conclusions: Similar characteristics of DCD were shown in comparison with DBD kidneys. Importantly, the additional warm ischemic time in DCD appeared to have no further detectable adverse effects on tissue injury, inflammation and complement activation. vWF, C4d and C3 might be potential biomarkers facilitating the evaluation of donor kidneys. View Full-Text
Keywords: complement activation; cold ischemic time; donation after brain death; donation after circulatory death; inflammation; tissue injury; warm ischemic time complement activation; cold ischemic time; donation after brain death; donation after circulatory death; inflammation; tissue injury; warm ischemic time
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Zwaini, Z.; Patel, M.; Stover, C.; Dormer, J.; Nicholson, M.L.; Hosgood, S.A.; Yang, B. Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death. Medicina 2020, 56, 317.

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