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Long-term outcomes of transplant kidneys donated after circulatory death
Amélie K Müller1, Eva Breuer1, Kerstin Hübel1,2
1Department of Surgery and Transplantation, University Hospital of Zürich, Zürich, Switzerland.
Insights
Kidney transplants from donation after circulatory death (DCD) offer long-term graft survival and function comparable to donation after brain death (DBD) kidneys. These DCD grafts are a valuable resource for transplantation.
Area of Science:
- Nephrology
- Transplantation Immunology
- Organ Donation
Background:
- Donation after circulatory death (DCD) accounts for up to 40% of kidney grafts used.
- While short- and mid-term outcomes are similar to donation after brain death (DBD) grafts, long-term data were lacking.
Purpose of the Study:
- To evaluate the long-term graft survival and function of kidney transplants from DCD donors compared to DBD donors.
- To provide data on outcomes exceeding 20 years post-transplantation.
Main Methods:
- Retrospective analysis of kidney transplant recipients between 1985 and 2000.
- One-to-one matching of DCD recipients with DBD recipients based on sex, age, and transplantation year.
- Follow-up until December 2020, with a median follow-up of 35 years.
Main Results:
- Median graft survival was 24.5 years for DCD and 23 years for DBD recipients (P=0.65), showing no significant difference.
- Delayed graft function was higher in DCD recipients (47 vs 23), but did not impact long-term survival.
- No significant differences in creatinine levels, proteinuria, or GFR slope were observed for grafts surviving over 20 years.
Conclusions:
- Kidney grafts from DCD donors demonstrate long-term survival and function comparable to DBD grafts.
- DCD kidney grafts are a valuable and reliable resource for transplantation.
- These findings support the continued utilization of DCD grafts with similar protocols to DBD grafts.
Background:
Donation after circulatory death (DCD) represents up to 40% of used kidney grafts. While studies have shown similar outcomes compared with donation after brain death (DBD) in the short term and mid-term, no data on long-term outcomes exist.
Methods:
We retrospectively analysed patients transplanted at our institution between January 1985 and March 2000. All DCD recipients were matched one-to-one with patients transplanted with DBD grafts during this period according to sex, age and year of transplantation and followed up until December 2020. During this period, 1133 kidney transplantations were performed, of which 122 were with a DCD graft.
Results:
The median graft survival after 35 years of follow-up was 23 years [277 months {95% confidence interval (CI) 182-372}] in DBD recipients and 24.5 years [289 months (95% CI 245-333)] in DCD recipients (P = 0.65; hazard ratio 0.91). Delayed graft function occurred in 47 patients in the DCD group compared with 23 in the DBD group (P < 0.001), albeit without a significant long-term outcome difference in graft or patient survival. We could not show any difference in graft function in terms of creatinine levels (133 versus 119 µmol/L), proteinuria (370 versus 240 mg/24 h) and glomerular filtration rate slope (-0.6 versus -0.3 mL/min/year) between the two groups for graft survival >20 years.
Conclusions:
This is the first study to show similar graft survival and function in DCD kidneys compared with DBD kidneys after 35 years of follow-up. DCD grafts are a valuable resource and can be utilized in the same way as DBD grafts.
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