Kidney Donation After Circulatory Death Is Associated With Sustained Graft Function, Comparable Graft, and Patient Survival.

BACKGROUND

Kidney transplantation is the preferred treatment for kidney failure, offering various benefits, yet donor supply remains limited worldwide, including in Australia and New Zealand. We examined long-term outcomes of kidney transplant recipients from donation after circulatory determination of death (DCDD) versus donation after neurological determination of death (DNDD) donors. Although DCDD kidneys carry a higher risk of delayed graft function (GF), long-term outcomes appear equivalent, but contemporary data on GF, particularly estimated glomerular filtration rate (eGFR), remain limited.

METHODS

Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we included adult kidney-only transplant recipients from 2010 to 2023. Cox proportional hazards models assessed death-censored graft survival and patient survival (PS), linear mixed models evaluated GF (eGFR), and logistic regression examined acute rejection within 12 mo.

RESULTS

Among 10 144 recipients (DNDD n = 7406, DCDD n = 2738), death-censored graft survival did not differ between groups (adjusted hazard ratio [aHR] DCDD versus DNDD [aHR, 1.08; 95% confidence intervals (CI), 0.94-1.24; P = 0.27]). PS was superior in the DCDD group (aHR, 0.58; 95% CI, 0.37-0.89; P = 0.01). DCDD recipients demonstrated a steeper early increase in eGFR with comparable long-term GF. Rejection within 12 mo was more common in DCDD recipients (odds ratio 1.36; 95% CI, 1.20-1.53; P < 0.001).

CONCLUSIONS

Despite a higher risk of early rejection, DCDD recipients had comparable graft and PS to DNDD recipients. Early GF improved rapidly in DCDD recipients and remained similar over time. These findings support the continued use of DCDD kidneys to expand the donor pool.