Kidney transplant outcomes from donation after circulatory death donors of advanced age

Abstract

BackgroundContinued comparison of kidney transplant outcomes between older DCD and donation after brain death (DBD) donors is needed to safely expand the deceased donor pool.MethodsWe performed a retrospective cohort study using the UNOS/OPTN transplant registry from donors >50 years old between 1994 and 2016. Donor age was stratified into 4 groups: 50‐54, 55‐59, 60‐64, and >65 years old. Rates of delayed graft function (DGF) and primary non‐function (PNF) were compared. Multivariable Cox regression models were constructed to identify factors associated with time to graft failure.ResultsThe DCD donors within each age group had fewer comorbidities than the DBD donors. Graft survival for DCD kidneys was equivalent or superior to DBD kidneys in all donor age groups. DGF rates were significantly greater for DCD kidneys in all age groups. PNF rates across all groups were similar. In multivariable analysis, DCD status was not independently associated with time to all‐cause graft failure in the 50‐54 donor age group (HR = 1.02, 95% CI = 0.93‐1.13), 55‐59 donor age group (HR = 1.07, 95% CI = 0.96‐1.19), or 60‐64 donor age group (HR = 1.135, 95% CI = 0.97‐1.32).ConclusionKidneys from carefully selected older DCD donors, particularly ages 50‐64, are a potential means to safely expand the deceased donor pool.

Post-Kidney Transplantation Results After Circulatory or Brain Death Without Pre-Mortem Heparin Administration

“…The results of our study agree with others concluding that the outcomes of DCD transplantations are fully comparable to those of DBD in the controlled transplantation regimen, even if older donors to ECD donors were included [ 27 ]. The high percentage of ECD (marginal) donors in the DCD group can be explained by the generally higher occurrence of physiological and laboratory pathologies in this type of donor, while in DBD donors, functions other than cerebral are often physiological.…”

Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

“…Several additional strategies for donor selection and preservation may optimize DCD organ utilization and improve waitlist outcomes. Older donors, for example, have been increasingly considered for DCD kidney transplantation, and this current analysis demonstrates that DCD kidney donors are significantly older than other DCD organ donors 28 . A recent US analysis found that the number of DCD kidney offers from donors ≥50 years has doubled, and accepting these offers was associated with a survival benefit over continuing to await transplantation 29 .…”

“…Older donors, for example, have been increasingly considered for DCD kidney transplantation, and this current analysis demonstrates that DCD kidney donors are significantly older than other DCD organ donors. 28 A recent US analysis found that the number of DCD kidney offers from donors ≥ 50 years has doubled, and accepting these offers was associated with a survival benefit over continuing to await transplantation. 29 Similarly, high-volume DCD liver transplantation centers in the United States have shown satisfactory survival with older DCD donors.…”

Delayed graft function: current status and future directions

“…The incidence of DGF ranges between 1.6 to 3.6% in living donor kidney transplantation (LDKT), 27–30.4% in deceased donor kidney transplantation (DDKT) which primarily includes donation after brain death (DBD) DDKT [5 ▪ ], and 45–55.1% in donation after circulatory death (DCD) DDKT [6]. To expand the donor pool and reduce wait times, lower-quality organs have been transplanted more recently [7], and still provide survival benefits compared to remaining on the waiting list [8]. Due to the expanding use of marginal organs, the incidence of DGF is increasing [3]…”