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Updated: Jun 12, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Kidneys from donors after cardiac death provide survival benefit
Maarten G Snoeijs1, Douglas E Schaubel, Ronald Hené
1Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, Netherlands. m.snoeijs@mumc.n
Insights
Donation after cardiac death (DCD) kidney transplants offer improved survival for patients with end-stage renal disease (ESRD) compared to remaining on dialysis. This study found DCD kidney recipients lived longer than those awaiting a brain-dead donor kidney.
Area of Science:
- Nephrology
- Transplantation Immunology
- Public Health
Background:
- Kidney transplantation is limited by donor organ shortages.
- Donation after cardiac death (DCD) offers a potential solution to expand the donor pool.
- Outcomes of DCD kidney transplantation compared to conventional brain-dead donor (DBD) transplantation remain unclear.
Purpose of the Study:
- To compare patient survival after receiving a DCD kidney versus remaining on dialysis and awaiting a DBD kidney.
- To evaluate the impact of DCD kidney transplantation on long-term patient outcomes.
Main Methods:
- Observational cohort study of 2575 patients on the Dutch kidney transplant waiting list (1999-2004).
- Comparison of outcomes between recipients of DCD kidneys (n=459) and DBD kidneys (n=680).
- Follow-up until death, living-donor transplant, or December 31, 2005.
Main Results:
- Graft failure within 3 months was higher for DCD kidneys (12%) than DBD kidneys (6.3%).
- Standard-criteria DCD transplantation was associated with a 56% reduced mortality risk compared to waiting for a DBD kidney.
- DCD kidney recipients gained an estimated 2.4 months of life over 4 years compared to those awaiting DBD kidneys.
Conclusions:
- Standard-criteria DCD kidney transplantation improves survival for end-stage renal disease (ESRD) patients awaiting a transplant.
- Despite higher early graft failure rates, DCD kidneys provide a survival benefit.
- Expanding DCD kidney transplantation is crucial for increasing donor availability and improving patient outcomes.
Abstract:
The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on dialysis and wait for a conventional kidney from a brain-dead donor (DBD). This observational cohort study included all 2575 patients who were registered on the Dutch waiting list for a first kidney transplant between January 1, 1999, and December 31, 2004. From listing until the earliest of death, living-donor kidney transplantation, or December 31, 2005, 459 patients received a DCD transplant and 680 patients received a DBD transplant. Graft failure during the first 3 months after transplantation was twice as likely for DCD kidneys than DBD kidneys (12 versus 6.3%; P=0.001). Standard-criteria DCD transplantation associated with a 56% reduced risk for mortality (hazard ratio 0.44; 95% confidence interval 0.24 to 0.80) compared with continuing on dialysis and awaiting a standard-criteria DBD kidney. This reduction in mortality translates into 2.4-month additional expected lifetime during the first 4 years after transplantation for recipients of DCD kidneys compared with patients who await a DBD kidney. In summary, standard-criteria DCD kidney transplantation associates with increased survival of patients who have ESRD and are on the transplant waiting list.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management