A Comparison of Kidney Transplant Outcomes Using Donation After Cardiac Death Donors Versus Donation After Brain Death Donors.

Abstract

Study aim: This single-centre study aimed to compare graft and patient outcomes between Donation after Brain Death (DBD) and Donation after Cardiac Death (DCD) renal transplant recipients. Methods: We retrospectively collected data on recipients who received a single kidney transplant from a deceased donor between 1/1/10 and 30/4/13. Primary endpoints were recipient survival, graft survival and graft function. Secondary endpoints were delayed graft function, length of post-transplant hospital admission and relevant transplant kidney biopsy findings. Results: There were 39 DCD and 91 DBD kidney recipients in total. There were no differences in recipient and graft survival. Graft function was comparable between the two groups within two months post-transplantation. 84.6% of DCD kidney recipients compared to 31.9% of DBD kidney recipients experienced delayed graft function (p < 0.001). DCD kidney recipients had a longer length of admission (median 9 v 7 days, p < 0.001) and 89.7% underwent a transplant biopsy before 31 days post-transplantation in comparison to only 48.3% of DBD kidney recipients (p < 0.001). There were no differences in rates of biopsy-defined acute rejection identified before 3 months or interstitial fibrosis / tubular atrophy at 12 months post-transplantation. Conclusion: This is the first Australian study to compare DCD and DBD kidney transplant outcomes. We found that although DCD kidneys experienced a significantly higher rate of delayed graft function, they quickly achieved a similar level of function to DBD kidneys and have the same medium-term graft survival and similar longer-term biopsy findings. Although longer-term data is required, these results suggest that DCD kidneys are a worthwhile group of organs and should continue to be utilised in Australia.