Kidney Transplant Outcome Following Donation After Euthanasia

Area of Science:

• Nephrology and Transplant Surgery
• Organ Donation and Transplantation
• Public Health Policy

Background:

• Organ donation after euthanasia (donation after circulatory death type V [DCD-V]) has increased in the Netherlands since 2012.
• The outcomes of DCD-V kidney grafts require thorough investigation to assess their safety and value in expanding the donor pool.

Purpose of the Study:

• To evaluate the outcomes of kidney transplantation using DCD-V grafts.
• To compare DCD-V kidney graft outcomes with those from donation after circulatory death type III (DCD-III) and donation after brain death (DBD).

Main Methods:

• Retrospective cohort study utilizing data from the Dutch Transplant Foundation (January 2012 - July 2023).
• Comparison of kidney transplants involving DCD-V grafts versus DCD-III and DBD grafts.
• Primary outcome: 5-year death-censored graft survival; Secondary outcomes: delayed graft function (DGF), permanent nonfunction (PNF), serum creatinine, and patient survival.

Main Results:

• DCD-V kidney transplants (n=145) showed a significantly lower incidence of DGF (26%) compared to DCD-III (49%) and similar rates to DBD (22%).
• Permanent nonfunction (PNF) rates were similar between DCD-V (6%) and DCD-III (6%), but higher than DBD (4%).
• Five-year death-censored graft survival (DCD-V: 82%, DCD-III: 86%, DBD: 84%) and patient survival (DCD-V: 69%, DCD-III: 76%, DBD: 73%) were comparable across all groups.

Conclusions:

• DCD-V kidney transplantation demonstrates a lower incidence of DGF compared to DCD-III.
• Long-term graft and patient survival rates for DCD-V kidney transplants are comparable to DCD-III and DBD.
• Findings support DCD-V as a safe and valuable method for increasing the kidney donor pool.