DCD kidneys provide survival benefit but continue to be declined and discarded at elevated rates. We aimed to characterize the potential benefit or harm associated with the clinical decision to accept or decline a DCD kidney offer when one becomes available.

METHODS: Using 2010-2014 SRTR data, we identified 101,439 adult kidney transplant candidates who were offered a DCD kidney that was eventually used for transplantation. Matching on center and time on dialysis, we used Cox regression to compare mortality between those who accepted DCD kidneys (n=7,932) vs declined (n=93,507). We tested the interaction between KDPI of the accepted DCD kidney and long-term benefit: high-KDPI (≥50) vs low-KDPI (<50).

RESULTS: Candidates who accepted DCDs had spent more time on dialysis than those who declined (3.4 (0.7-5.5) vs 2.0 (0.17-3.8) years, p<0.001). Among those who declined, 23.8% later received DBDs and 5.8% received DCDs after waiting an additional 12.0 (4.5-23.2) and 12.2 (4.5-24.0) months, respectively. Within the first month, survival was 99.2%, 98.8%, and 99.6% for those who accepted low-KDPI, accepted high-KDPI, and declined DCDs, respectively (Figure 1). Following the perioperative risk period, those who accepted DCDs experienced a statistically significant reduction in risk of death from 1 month to beyond 3 years post-transplant (Table 1). This reduction in risk of death translated to 86.8% and 82.8% survival for those who accepted low and high-KDPI DCDs and 78.0% survival for those who declined (p<0.001, Figure 1). Benefit conferred from accepting a DCD offer did not differ by KDPI of the offer (p-interactions>0.3).

CONCLUSION: Those who accepted DCD offers experienced long-term improved survival compared to those who declined DCD offers. More acceptance of DCD kidney offers might improve outcomes for the right patients.

CITATION INFORMATION: Bowring M, Massie A, Segev D. Higher Mortality Among Candidates Who Refuse to Accept DCD Kidney Offers. Am J Transplant. 2017;17 (suppl 3).

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