Experience With 117 Donation After Circulatory Death Expanded Criteria Donor Kidney Transplants: What Are the Limits of Acceptability?

INTRODUCTION

Nonuse of expanded criteria donor (ECD) kidneys from donation after cardiocirculatory death (DCD) donors remains high. The study purpose was to analyze our experience with kidney transplantation (KT) from DCD donors stratified by ECD versus non-ECD (standard criteria donor [SCD]).

METHODS

Single center retrospective cohort study of all primary DCD KT recipients.

RESULTS

From April 2003 to January 2024, we performed 671 primary DCD KTs (554 from DCD/SCDs and 117 from DCD/ECDs). Mean donor and recipient ages were 38.3 ± 14.6 DCD/SCD versus 59.4 ± 4.5 years DCD/ECD and 54.0 ± 13.1 DCD/SCD versus 63.0 ± 7.7 years DCD/ECD, respectively (both p < 0.05). Mean Kidney Donor Profile Index (KDPI) values were 53 ± 23% DCD/SCD versus 85 ± 9% DCD/ECD (p < 0.05). With a mean follow-up of 71 months DCD/SCD and 58 months DCD/ECD, patient (76.2% DCD/SCD vs. 72.6% DCD/ECD) and graft survival (61.6% DCD/SCD vs. 61.5% DCD/ECD) rates were comparable. Rates of primary nonfunction/thrombosis and delayed graft function were 3.4% for both DCD/SCD and DCD/ECD and 49% DCD/SCD versus 56% DCD/ECD, respectively (both p = NS). The presence of DGF did not influence survival outcomes in DCD/ECD KTs whereas inferior graft survival was noted in DCD/SCD KTs with DGF. However, DGF did have a negative effect on renal function in all groups. DCD/ECD KTs with or without DGF had comparable outcomes to DCD/SCD KTs with DGF.

CONCLUSIONS

DCD/ECD KTs are associated with inferior functional but similar mid-term survival outcomes compared to DCD/SCD KTs with DGF. The presence of DGF appears to have a differential effect on survival outcomes in these two groups.