ORIGINAL ARTICLE
Survival benefit of accepting kidneys from older donation after cardiac death donors

https://doi.org/10.1111/ajt.16198Get rights and content
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Kidneys from older (age ≥50 years) donation after cardiac death (DCD50) donors are less likely to be transplanted due to inferior posttransplant outcomes. However, candidates who decline a DCD50 offer must wait for an uncertain future offer. To characterize the survival benefit of accepting DCD50 kidneys, we used 2010-2018 Scientific Registry for Transplant Recipients (SRTR) data to identify 92 081 adult kidney transplantation candidates who were offered a DCD50 kidney that was eventually accepted for transplantation. DCD50 kidneys offered to candidates increased from 590 in 2010 to 1441 in 2018. However, 34.6% of DCD50 kidneys were discarded. Candidates who accepted DCD50 offers had 49% decreased mortality risk (adjusted hazard ratio [aHR] 0.460.510.55, cumulative mortality at 6-year 23.3% vs 34.0%, P < .001) compared with those who declined the same offer (decliners). Six years after their initial DCD50 offer decline, 43.0% of decliners received a deceased donor kidney transplant (DDKT), 6.3% received living donor kidney transplant (LDKT), 22.6% died, 22.0% were removed for other reasons, and 6.0% were still on the waitlist. Comparable survival benefit was observed even with DCD donors age ≥60 (aHR: 0.420.520.65, P < .001). Accepting DCD50 kidneys was associated with a substantial survival benefit; providers and patients should consider these benefits when evaluating offers.

KEYWORDS

clinical decision-making
clinical research/practice
donors and donation: donation after circulatory death (DCD)
epidemiology
health services and outcomes research
kidney transplantation/nephrology
organ procurement and allocation
patient survival
Scientific Registry for Transplant Recipients (SRTR)

Abbreviations

aHR
adjusted hazard ratio
aIRR
adjusted incidence ratio
aOR
adjusted odds ratio
CAKUT
congenital anomalies of kidney and urinary tract
cPRA
calculated panel-reactive antibody
DBD
donation after brain death
DCD
donation after cardiac death
DCD50
donation after cardiac death donor age ≥50
DCD60
donation after cardiac death donor age ≥60
DDKT
deceased donor kidney transplant
DGF
delayed graft function
eGFR
estimated GFRs
ESRD
end-stage renal disease
HCV
hepatitis c virus
HRSA
Health Resources and Services Administration
IQR
interquartile range
KDPI
kidney donor profile index
KT
kidney transplant
LDKT
living donor kidney transplantation
OPTN
Organ Procurement Transplantation Network
SD
standard deviation
SRTR
Scientific Registry for Transplant Recipients
UK
United Kingdom
US
United States

Cited by (0)

Sile Yu and Jane J. Long contributed equally to the manuscript.