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Am J Transplant. 2018 Jun 27. doi: 10.1111/ajt.14989. [Epub ahead of print]

Transplantation of kidneys from DCD and DBD donors who died after ligature asphyxiation: The UK experience.

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National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Organ Donation and Transplantation, University of Cambridge, Newcastle University, Newcastle upon Tyne, UK.
NHS Blood and Transplant (NHSBT), NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
NHS Blood and Transplant Organ Donation and Transplantation, Bristol, UK.
Laboratory of Abdominal Transplantation, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.
The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.


There is uncertainty about whether hypoxic injury accompanying donor death from ligature asphyxiation influences renal transplant outcomes, particularly for recipients of kidneys donated after circulatory death (DCD). The UK Registry analysis was undertaken to determine transplant outcomes in recipients of kidneys from donors who died following ligature asphyxiation. From 2003 to 2016, 2.7% (n = 521) of potential organ donors died following ligature asphyxiation (mostly suicide by hanging). Of these, 409 (78.5%) donated kidneys for transplantation (46.9% donation after brain death [DBD] and 53.1% DCD donors) resulting in 650 kidney transplants. Compared to other deceased donors, those dying from ligature asphyxiation were younger, more often male, and had less hypertension. Unadjusted patient and graft survival were superior for recipients of both DBD and DCD kidneys from donors dying after ligature asphyxiation, although after adjustment for donor/recipient variables, transplant outcomes were similar. A case-control matched analysis confirmed transplant outcomes for those who received kidneys from donors dying after ligature asphyxiation were similar to controls. Although caution is required in interpreting these findings because of potential selection bias, kidneys from donors dying of ligature asphyxiation suffer an additional warm ischemic insult that does not apparently adversely influence transplant outcomes, even for kidneys from DCD donors.


clinical research/practice; donors and donation; donors and donation: deceased; ischemia reperfusion injury (IRI); kidney (allograft) function/dysfunction; kidney transplantation/nephrology; organ procurement and allocation


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