Kidney Allograft Outcomes of Dual-Organ Heart Kidney Transplant Recipients Following Donation After Circulatory Determination of Death.

INTRODUCTION

Simultaneous Heart-Kidney Transplantation (SHKT) following donation after circulatory determination of death (DCD) is increasing. Whether kidney allograft outcomes differ from donation after brain death (DBD) SHKT recipients has not been well studied.

METHODS

We identified adults in the UNOS database who were listed for SHKT and transplanted after 2018. Baseline characteristics of DBD and DCD recipients and donors were compared. Outcomes of interest included primary nonreceipt of a kidney allograft, acute post-transplant dialysis, and chronic dialysis or renal transplantation. Survival to 1-year and renal allograft function at follow up were also assessed. Univariate and multivariable logistic regression were used to identify risk factors for the individual outcomes with Cox proportional hazard modeling leveraged to identify risk factors for 1-year mortality. One-year survival was compared between both groups using Kaplan-Meier and Cox-Hazards ratio.

RESULTS

From October 18, 2018 to December 31, 2023, there were 1956 SHKT recipients, with 1828 receiving allografts from DBD donors and 128 from DCD donors. DCD recipients were significantly older, listed at lower transplant status, and less likely to be on inotropic or intra-aortic balloon pump support before transplant. DCD donors were younger and had higher baseline eGFR. After a median follow-up of 847 days, there was no significant difference in renal allograft outcomes between groups. There was no difference in 1-year survival between DCD and DBD SHKT recipients, and DCD status was not associated with 1-year survival after adjustment for key donor and recipient characteristics.

CONCLUSION

Kidney allograft outcomes are similar in DBD and DCD SHKT recipients, which supports DCD in expanding the donor pool for SHKT candidates.