Despite having a higher incidence of delayed graft function, transplant patients who receive a kidney donation after circulatory determination of death (DCD) have graft survival similar to those who receive a kidney donation after brain death (DBD), according to a new study.
From 1985 to March 2000, 1133 kidney transplantations were performed at the University Hospital Zurich in Switzerland. From this cohort, investigators matched 122 patients with a DCD graft to 122 patients with a DBD graft by sex, age, and year of transplantation.
Median graft survival after 35 years of follow-up was 24.5 years in DCD and 23 years in DBD recipients – a nonsignificant difference, Olivier de Rougemont, MD, and colleagues from the University Hospital Zurich reported in Nephrology Dialysis Transplantation.
Delayed graft function occurred in significantly more patients in the DCD than DBD group: 47 vs 23. Those with delayed graft function in the DCD group had no worse graft or patient survival, however.
Further, the 71 kidney transplant recipients with graft survival exceeding 20 years had good graft function. There were no significant differences in graft function in the DCD vs DBD group with respect to serum creatinine (133 vs 119 µmol/L), proteinuria (370 vs 240 mg/24 h), estimated glomerular filtration rate (eGFR; 45.5 vs 55.0 mL/min/1.73 m2), or eGFR slope (-0.6 vs -0.3 mL/min/year).
The odds of graft survival was 2-fold lower when donors were older than 60 years rather than younger.
“In conclusion our results indicate that criteria for selecting grafts for deceased kidney transplantation should not be based on the type of organ donation,” Dr de Rougemont’s team stated. “Outcomes of DBD and DCD kidney graft transplantation in terms of function and survival are similar even after over thirty years and [delayed graft function] per se is not detrimental for the long-term outcome.”
Müller AK, Breuer E, Hübel K, et al. Long-term outcomes of transplant kidneys donated after circulatory death. Nephrol Dial Transplant. Published online December 17, 2022. doi:10.1093/ndt/gfab358/6468756