Even after decades of follow-up, kidneys transplanted after circulatory determination of death (DCD) show similar outcomes to kidneys donated after brain death (DBD), reports a study in Nephrology Dialysis Transplantation.
Of 1133 kidney transplants performed between 1985 and 2000 at the authors’ Swiss medical center, 122 used DCD grafts. The DCD kidney recipients—74 men and 48 women, median age 46 years—were matched one to one for sex, age, and transplant year to patients receiving DBD grafts during the same period. Outcomes were assessed through 2020.
At 35 years’ follow-up, median graft survival was almost identical between groups: 24.5 years for DCD recipients versus 23 years for DBD recipients. Delayed graft function was more common in DCD recipients—47 patients—compared with 23 patients after DBD transplants. However, there were no long-term differences in graft or patient survival.
Among patients with more than 20 years of graft survival, measures of graft function were similar between groups. The slope of change in glomerular filtration rate was −0.6 mL/min/year in the DCD group and −0.3 mL/min/year in the DBD group. Creatinine levels were 133 versus 119 μmol, and proteinuria was 370 versus 240 mg per 24 hours, respectively.
Kidneys donated after cardiovascular death are an important source of organs for transplantation. Studies have reported similar outcomes for DCD and DBD kidneys up to 10 years, but there are few data on longer-term outcomes.
This 35-year follow-up study shows similar graft survival and excellent function with DCD versus DBD kidneys. Good outcomes are achieved despite the higher rate of delayed graft function in DCD organs. The researchers conclude: “[O]ur results indicate that criteria for selecting grafts for deceased kidney transplantation should not be based on the type of organ donation” [Müller A, et al. Long-term outcomes of transplant kidneys donated after circulatory death. Nephrol Dial Transplant, published online ahead of print December 17, 2021. doi: 10.1093/ndt/gfab358; https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfab358/6468756].