Kidney transplant outcome of expanded criteria donors after circulatory death

Area of Science:

• Nephrology
• Transplantation Surgery
• Organ Donation

Background:

• Rising kidney transplant waiting lists necessitate expanding donor pools.
• Donors after cardiac death (DCD) and expanded criteria donors (ECD) are increasingly utilized.
• Controlled DCD (cDCD) grafts, despite higher delayed graft function (DGF), show comparable long-term outcomes to brain-dead donors.

Purpose of the Study:

• To evaluate the outcomes of kidney transplants using cDCD/ECD grafts.
• To compare the efficacy of cDCD/ECD grafts against other donor types.
• To assess factors influencing mortality and graft survival in cDCD/ECD recipients.

Main Methods:

• Analysis of kidney transplant data involving cDCD/ECD grafts.
• Comparison of graft function, survival rates, and recipient mortality.
• Evaluation of recipient age and surgical factors (cold ischemia time).

Main Results:

• cDCD/ECD grafts are associated with increased DGF but similar long-term graft survival compared to brain-dead expanded criteria donors.
• Recipients of cDCD/ECD grafts exhibit poorer kidney function than those receiving cDCD/standard or brain-dead/ECD grafts.
• Recipient age is a primary factor in mortality for cDCD/ECD recipients; survival benefits are noted for cDCD/≥60 grafts.

Conclusions:

• cDCD/ECD grafts are a viable option to shorten kidney transplant waiting lists.
• Optimizing surgical techniques and minimizing cold ischemia are crucial for cDCD/ECD graft success.
• Careful patient selection, considering recipient age, is essential for maximizing survival benefits.