Donation after cardiac death (DCD) donor kidneys increase the organ pool but use in kidney retransplantation (KRTx) has been questioned due to higher rates of delayed graft function (DGF) and lower expected survival. Study purpose was to analyze our experience with recipients of DCD-standard criteria donor (SCD) kidneys stratified by primary vs KRTx. METHODS: Single center retrospective review of all DCD/SCD KTxs. Recipient selection was based on predicted ability to tolerate a higher rate of DGF with informed consent. RESULTS: From 4/03-9/16, we performed 289 DCD/SCD KTxs (252 primary & 37 KRTxs). There were no significant differences in mean donor age (37.2 primary vs 40.1 yrs KRTx), estimated creatinine clearance (CrCl;114 vs 121 ml/min), warm ischemia time (23 vs 25 mins), cold ischemia time (27.5 vs 26.6 hrs) and KDPI (49% vs 52%). There were 18 dual KTxs in the primary vs none in the KRTx group. Mean recipient ages (52 primary vs 49 yrs KRTx), waiting times (24.9 vs 29 months), and dialysis durations (41.7 vs 51.5 months) were comparable. There were more sensitized patients (pts, cPRA ≥20%) among KRTx (14.7% primary vs 51.4%, p<.0001) and fewer HLA-mismatches (4.2 vs 3.6, p<.05). With a mean follow-up of 5 years, pt survival (85.3% primary vs 78.4% KRTx), graft survival (GS, 67.5% vs 64.9% ), and death-censored GS rates (75.5% vs 70.6%, see also Figure 1) were comparable as were 1-year pt (96% vs 89%, p=.07) & GS (89.7% vs 83.8%, p=.27) rates. Rate of primary nonfunction (PNF, 4% primary vs 13.5% KRTx, p=0.03) was higher whereas DGF rates (53% vs 62%, NS) and mean 2-year eGFR (48 vs 53 ml/min/1.73 m²) were similar for KRTxs. In 6 pts who received 3^rd transplants, pt and kidney GS rates were 50%. CONCLUSIONS: KRTx from DCD/SCDs is associated with a higher rate of PNF and slightly higher early mortality but mid-term survival and functional outcomes are comparable to primary KTx from DCD/SCDs.

CITATION INFORMATION: Khan M, Alradawna B, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Gautreaux M, Doares W, Kaczmorsky S, Stratta R. Kidney Re-Transplantation (KRTx) from Donation After Cardiocirculatory Death (DCD)-Standard Criteria Donors (SCD). Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress