Simultaneous Heart and Kidney Transplantation Using Circulatory Death Donors: Are Kidney Graft Outcomes Comparable With Brain Death Donors?

BACKGROUND

There is limited evidence on heart and kidney transplants using donation after circulatory death (DCD) donors, especially regarding graft outcomes. However, little is known about the use of DCD donors for simultaneous heart and kidney transplants (SHKTs) compared with SHKTs using donation after brain death (DBD) donors.

METHODS

From May 22, 2020, to September 30, 2023, 1129 adult patients received SHKTs (DCD, N = 91 versus DBD, N = 1038), identified using the United Network for Organ Sharing database, excluding other multiorgan transplants and retransplants. A propensity score matching was performed using characteristics. Ninety-one DCD- and 273 DBD-matched cases were compared.

RESULTS

In the unmatched cohort, DCD recipients were older (DCD: 60 versus DBD: 58 y, P = 0.03), had a lower rate of dialysis at transplant (27% versus 40%, P = 0.03), and were of status 1 to 2 (43% versus 72%, P < 0.001). In the matched cohort, kidney delayed graft function (27% versus 22%, P = 0.29) was comparable, as were recipient survival (P = 0.19), heart graft survival (P = 0.19), and kidney graft survival (P = 0.17). In multivariate Cox proportional hazards analysis, donor type (DCD) was not associated with an increased risk of mortality (hazard ratio, 1.69; 95% confidence interval, 0.90-3.16; P = 0.10). Subgroup analysis showed that survival and freedom from graft failures were comparable between different modes of DCD recovery.

CONCLUSIONS

SHKT using DCD donors yields comparable survival and graft outcomes to those using DBD donors. These findings may help donor selection in heart transplant candidates with kidney dysfunction.