Kidney Transplantation from Uncontrolled Donation after Circulatory Death, our Outcomes Compared to Donation after Brain Death after Very Long Time

Abstract

Introduction Kidney transplantation (KT) is the best renal replacement therapy but the shortage of organ is the main limitation. Uncontrolled Donation after Circulatory Death (uDCD) increases the available organs with similar outcomes than donors after brain death (DBD). The long-term outcome of uDCD compared to standard criteria donors after DBD KT is unknown. Methods We compared the long-term follow-up (10 y) of all uDCD KT procured since June 2005 to December 2013 (n=237) with a cohort of first KT of DBD performed between 2004 and 2014 (237) in the same institution. We review renal function, graft and recipient survival. We studied factors related with graft survival. Results Primary non-function was similar between both groups (uDCD 6.8% vs. 4.2%, p=0.16). Despite the higher delayed graft function (DGF) in uDCD (73.4% vs. 46.4%, p<0.01), renal function was similar between the two groups in the follow-up with exception the first six months (FG 51±17 ml/min vs 55±19 ml/min, p=0.04), Figure 1. Graft and recipient survival were equivalent in both groups after 10 years (82% vs. 80%, p=0.6 and 86% vs 88%, p=0.45, respectively), Figure 2. In multivariable analysis, proteinuria >0.5 after 3, 6 and 12 months (HR 5.1 CI 1.2-5.4, p<0.05) and GFR < 45 ml/min (HR 6.2 CI 1.8-21.5, p<0.05) had a deleterious impact in uDCD donors (HR 2.5 CI 1.01-6.3, p=0.04) while DGF had any impact (p>0.05). Conclusions KT from uDCD has similar renal function, graft and recipient survival than DBD after long-term of follow-up. The main factors related with graft survival were proteinuria > 0.5 g/day at 3, 6 and 12 months and GFR < 45 ml/min at 12 months.