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Uncontrolled donation after cardiac death kidney transplantation: Opportunity to expand the donor pool?

Published:December 19, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.12.014

      Highlights

      • Ten-year graft and patient survival similar between uDCD and cDCD kidney allografts.
      • uDCD kidney allograft recipients experienced higher rates of primary non-function.
      • uDCD is a viable source of kidney allografts amid shortages in the US organ pool.

      Abstract

      Background

      Compared to controlled donation after cardiac death (cDCD), uncontrolled DCD (uDCD) kidney transplantation remains an underutilized resource in the United States. However, it is unclear whether long-term allograft outcomes following uDCD are inferior to that of cDCD kidney transplantation.

      Methods

      From January 1995 to January 2018, the OPTN/UNOS database was queried to discover all reported cases of uDCD and cDCD kidney transplantation. Primary non-function, delayed graft function, ten-year graft and patient survival were compared among uDCD and cDCD patients.

      Results

      Rates of primary non-function (4.0% [uDCD] vs. 1.8% [cDCD], P < 0.001) and delayed graft function (51.1% [uDCD] vs. 41.7% [cDCD], P < 0.001) were higher following uDCD transplant. However, ten-year graft survival (47.5% [uDCD] vs. 48.4% [cDCD], P = 0.21) and patient survival were similar to cDCD transplantation (59.4% [uDCD] vs. 59.2% [cDCD], P = 0.32).

      Conclusion

      Although initial allograft outcomes are inferior following uDCD, long-term durability of uDCD kidney allografts is on par to cDCD transplantation. Kidney allografts derived by uDCD may be a viable and durable option to increase the donor pool.

      Graphical abstract

      Keywords

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