Elsevier

EClinicalMedicine

Volumes 4–5, October–November 2018, Pages 25-31
EClinicalMedicine

Research Paper
Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation

https://doi.org/10.1016/j.eclinm.2018.09.007Get rights and content
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Highlights

  • In the Netherlands, there is a frequent and liberal use of renal grafts donated after cardiac death.

  • Grafts donated after cardiac death present with high incidences of early graft loss and delayed graft function

  • Yet, grafts donated after cardiac and brain death show equivalent 10 year transplantation outcomes

  • Long-term outcome equivalence relates to a reduced impact of delayed graft function on graft survival of grafts donated after cardiac death.

Abstract

Background

Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified.

Methods

This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses.

Findings

Despite higher incidences of early graft loss (+ 50%) and delayed graft function (+ 250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5–75.2), combined recipient survival: 64.5% (95 CI: 63.0–66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55–0.87), p < 0.001). Mid and long-term graft function (eGFR), and the impact of incident delayed graft function on eGFR were similar for DBD and DCD grafts.

Interpretation

Mid and long term outcomes for DCD grafts are equivalent to DBD kidneys. Poorer short term outcomes are offset by a lesser impact of delayed graft function on DCD graft survival. This nation-wide evaluation does not justify the reluctance to use of DCD renal grafts. A strong focus on short-term outcome neglects the superior recovery potential of DCD grafts.

Keywords

Kidney transplantation
Donation after cardiac death
Donation after brain death
Outcome
Graft survival
Delayed graft function

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