Kidney transplant candidates who accept kidneys from older donation after cardiac death (DCD) donors have improved survival compared with those who do not, investigators reported at the American Transplant Congress 2020 virtual scientific program.
Sile Yu, MD, MPH, and colleagues at Johns Hopkins University School of Medicine in Baltimore used 2010-2018 data from the Scientific Registry of Transplant Recipients to study 92,081 adult kidney transplant candidates who were offered an older DCD kidney (aged 50 years or older). The study population included 3617 candidates who accepted an older DCD kidney and 88,461 who declined the offer. The investigators followed them from the date of offer until death or administrative censoring.
At 6 years, the cumulative mortality rate was 23% among acceptors compared with 34% among decliners, Dr Yu reported in a video presentation. After adjusting for potential confounders, acceptors had a significant 50% decreased risk of death compared with decliners. The survival benefit of accepting an older DCD kidney was more pronounced among patients on dialysis at the time a kidney was offered. In this group, kidney acceptance was significantly associated with a 54% decreased risk of death compared with kidney refusal. Among candidates listed for a preemptive transplant, acceptance was significantly associated with a 31% decreased risk of death compared with declining a kidney.
Among candidates who refused an older DCD kidney, 6% were still waiting for a kidney, 6.3% received a kidney from a living donor, 40.9% received a kidney from another deceased donor, 22% were removed from the transplant waiting list, and 22.6% died.
Candidates who accepted an older DCD kidney were significantly older at the time the kidney was offered than those who did not (median 60 vs 56 years) and less likely to be male (62.4% vs 65.9%).
“Broader acceptance of DCD offers from well-selected older DCD donors could improve long-term survival for kidney waiting list candidates, especially for those who are on dialysis at the time offer,” Dr Yu concluded.
Yu S, Long J, Yu Y, et al. Survival benefit of accepting kidneys from older donation after cardiac death donors. Am J Transplant 2020;20 (suppl 3). Presented at the ATC 2020 virtual congress program. Abstract 13.