[A COMPARATIVE STUDY OF DONATION AFTER BRAIN DEATH, DONATION AFTER CARDIAC DEATH, AND LIVING-DONOR KIDNEY TRANSPLANTATION].

(Objective) Since the revision of the Organ Transplant Law in our country in 2010, the primary source of deceased organ donation has shifted from donation after cardiac death (DCD) to donation after brain death (DBD). Although the graft survival rate of living donor (LD) kidney transplantation has generally surpassed that of deceased donor kidney transplantation, few studies have directly compared outcomes between DCD and DBD. (Subjects and methods) We conducted a retrospective analysis of 213 patients who underwent kidney transplantation at our institution between 2011 and 2023. ABO-incompatible transplants and those with pre-existing anti-donor HLA antibodies were excluded. Patients were categorized into three groups according to donor status: DCD (n = 25), DBD (n = 39), and LD (n = 149). (Results) The median recipient ages were 56 years (DCD), 52 years (DBD), and 41 years (LD), while the median donor ages were 47 years (DCD), 45 years (DBD), and 61 years (LD). The proportion of HLA-DR 0 mismatch was 36% in DCD, 59% in DBD, and 24.8% in LD. Graft survival rates at 10 years were 83.2% for DCD; 100% for DBD; and 88.3% for LD, respectively.Multivariate analysis identified biopsy proven rejection as the only independent predictor of graft survival. (Conclusion) Despite the disadvantages of longer ischemic times and dialysis durations prior to transplantation, DBD grafts demonstrated the highest graft survival rates. These favorable outcomes may be attributed to a lower frequency of HLA-DR mismatches and reduced incidence of rejection.