Objective: To evaluate the clinical outcomes of kidney transplantation from uncontrolled donation after circulatory death (uDCD) donors at a single transplant center, with a specific focus on comparing two organ preservation strategies: normothermic regional perfusion (NRP) and hypothermic in situ perfusion (ICP).
Materials and Methods: A retrospective analysis was conducted on 311 kidney transplantations performed at Botkin Hospital between January 1, 2021 and December 31, 2023. Donors were classified as standard criteria donors (SCD), expanded criteria donors (ECD), and uDCD donors. The uDCD group included 39 cases. Donor and recipient characteristics, preservation techniques, delayed graft function (DGF), primary non-function (PNF), hemodialysis requirements, and graft survival were assessed.
Results: The uDCD group demonstrated a higher incidence of DGF (64.1%) and PNF (10.3%) compared to the SCD and ECD groups. However, the one-year graft survival rate was 87.2% and did not significantly differ from other donor types. Within the uDCD cohort, comparison between NRP and ICP showed a significantly lower intraoperative resistive index in the NRP group (0.5 vs. 0.8; p = 0.009) and a trend toward better graft function at 12 months, despite higher rates of DGF and increased need for hemodialysis.
Conclusion: Kidney transplantation from uDCD donors is a safe and viable option that can provide comparable long-term outcomes when clinical protocols are properly followed. Normothermic regional perfusion may offer advantages in intraoperative hemodynamics and long-term graft function, despite a more complex early postoperative course. Further multicenter studies are needed to optimize donor selection and preservation methods for uDCD transplantation.