Abstract
Kidney transplants from donors after circulatory death (DCD) make up an increasing proportion of all deceased donor kidney transplants in the United States (US). However, DCD grafts are considered to be of lower quality than kidneys from donors after brain death (DBD). It is unclear whether graft survival is different for these two types of donor kidneys. We conducted a retrospective cohort study of US deceased donor kidney recipients using data from the United Network of Organ Sharing from 12/4/2014 to 6/30/2018. We employed a Cox proportional hazard model with mixed effects to compare all-cause graft loss and death-censored graft loss for DCD versus DBD deceased donor kidney transplant recipients. We used transplant center as the random effects term to account for cluster-specific random effects. In the multivariable analysis, we adjusted for recipient characteristics, donor factors, and transplant logistics. Our cohort included 27,494 DBD and 7,770 DCD graft recipients transplanted from 2014 to 2018 who were followed over a median of 1.92 years (IQR 1.08-2.83). For DCD compared with DBD recipients, we did not find a significant difference in all-cause graft loss (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 in univariable and HR 1.03 [95% CI 0.95-1.13] in multivariable analysis) or for death-censored graft loss (HR 0.97 (95% CI 0.91-1.06) in univariable and 1.05 (95% CI 0.99-1.11) in multivariable analysis). For a contemporary cohort of deceased donor kidney transplant recipients, we did not find a difference in the likelihood of graft loss for DCD compared with DBD grafts. These findings signal a need for additional investigation into whether DCD status independently contributes to other important outcomes for current kidney transplant recipients and indices of graft quality.
Highlights
In 2016, nearly 100,000 patients were listed on the United States (US) deceased donor kidney transplant waitlist, and 20% of these patients had been waiting for at least six years [1]
For donors after circulatory death (DCD) compared with donors after brain death (DBD) recipients, we did not find a significant difference in all-cause graft loss or for death-censored graft loss (HR 0.97 in univariable and 1.05 in multivariable analysis)
For a contemporary cohort of deceased donor kidney transplant recipients, we did not find a difference in the likelihood of graft loss for DCD compared with DBD grafts
Summary
In 2016, nearly 100,000 patients were listed on the United States (US) deceased donor kidney transplant waitlist, and 20% of these patients had been waiting for at least six years [1]. These stark figures reflect an ongoing shortage of donor kidneys and fuel interest in both expanding the pool of potential donors and optimizing the use of available kidneys [2]. The majority of deceased donor kidneys come from donors after brain death (DBD) who have died by neurologic criteria Since their introduction in 1993, donors after circulatory death (DCD) make up a growing proportion of all deceased donor kidneys. DCD grafts are considered to be of lower quality than kidneys from donors after brain death (DBD). It is unclear whether graft survival is different for these two types of donor kidneys
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