Kidney Transplantation From Donors After Controlled Cardiac Death: Influence of Delayed Graft Function On One-Year Outcomes.

Abstract

Background: The availability of donor kidneys has failed to keep pace with demand, resulting in an ever-growing waiting list of potential recipients. In 2012, a donation after controlled cardiac death (DCD) procurement and transplant program was established at our Hospital. This strategy has allowed us to increase the number of kidney transplants (KT). However, one of the major concerns is the high incidence of delayed graft function (DGF) observed in such transplants. Aim: to compare the risks factors associated with DGF and it impact on one-year graft outcomes between controlled DCD and donation after brain death (DBD) kidney transplants. Methods: single-center retrospective study of DCD and DBD donor KT. We compared 1-year graft survival rates, 1-year estimated glomerular filtration rate (e-GFR) as well as the different factors associated with the risk of DGF between the two groups. Results: From 2009 to 2013, 81 deceased donor KT were performed, 56 (69%) from DBD and 25 (31%) from DCD donors. A significantly lower proportion of DCD recipients received < 3 human leukocyte antigen (HLA) mismatched kidneys (8% vs. 31,5%, p=0,02). Cold ischemia time (CIT) was significantly lower in the DCD group (7.5±5 vs 12.5±7.3 h, p=0.003). Incidence of DGF was higher among DCD recipients (52% vs. 18%, P=0.002), but there were no differences in the median duration on days. On multivariate analysis, risk factors significantly associated with DGF were cerebrovascular cause of death in the DCD group (OR 4.7, IC 95% 2,3-12,5 p=0.008 ) and male recipients of KT from female donor in DBD group (OR 4,5 IC 95% 1.1-19,3 p=0,04). DGF did not affect one-year graft survival within the DCD cohort (100% vs 100%) or the DBD group (91% vs 100% p=0,38). The e-GFR at one-year were comparable in the DCD group with or without DGF (44,4±10,6 vs 51,8±12,5 ml/min, p=0,29) and in DBD group with or without DGF (48,3±20,2 vs 54,6±17 ml/min, p=0,36) Conclusion: Despite the higher incidence of DGF observed in KT from controlled DCD donors compared with DBD donors, it does not seem to have an adverse impact on graft outcomes in the context of relatively short CITs. This results may contribute to stimulate the implementation of controlled DCD kidney transplant programs. This study was supported by a joined unrestricted grant from Novartis and Astelas