Infection risk in kidney transplantation from uncontrolled donation after circulatory death donors

Area of Science:

• Nephrology
• Transplantation immunology
• Infectious disease epidemiology

Background:

• Uncontrolled donation after circulatory death (DCD) kidney transplantation (KT) is associated with increased risks of delayed graft function (DGF) and use of antithymocyte globulin (ATG)-containing therapies, potential risk factors for post-transplant infection.
• Donation after brain death (DBD) serves as a comparator for assessing DCD outcomes.

Purpose of the Study:

• To compare the incidence of infection in kidney transplant recipients from uncontrolled DCD donors versus donation after brain death (DBD) donors.
• To evaluate the safety of uncontrolled DCD kidney transplantation policies concerning post-transplant infection risk.

Main Methods:

• A prospective cohort study included 291 kidney transplant recipients between November 2008 and July 2011.
• Patients were categorized into DCD (n=87) and DBD (n=204) groups, with most DCD donors being uncontrolled Maastricht categories 1 or 2.
• Backward stepwise Cox proportional hazards models were employed to analyze the impact of DCD on infection rates.

Main Results:

• DCD recipients had a lower cumulative incidence of overall, bacterial, cytomegalovirus (CMV), and non-CMV viral infections compared to DBD recipients (P < .05 for all).
• Multivariate analysis revealed DCD was associated with a significantly lower risk of overall infection (hazard ratio: 0.41; P = .012), even with ATG induction.
• No significant difference in overall infection incidence was observed between DCD recipients and age-matched DBD controls (43.7% vs 47.1%, P = .648).

Conclusions:

• Uncontrolled DCD kidney transplantation policies are safe regarding the risk of post-transplant infection.
• Despite higher rates of DGF and the use of ATG-containing therapies, DCD kidney transplantation does not increase infection risk.