Introduction: Donation after circulatory death (DCD) kidneys represent 15% of the deceased donor kidneys transplanted in the United States. A majority of transplant centers will allow 1 hour after withdrawal of support to donor death to consider using kidneys, whereas our center has consistently allowed 2 hours. There has never been a comparison of outcomes of transplantation using organs after 1 vs 2 hours of time after withdrawal. We hypothesized that waiting longer would be associated with worse outcome.

Methods: A single-center, retrospective analysis of DCD organs transplanted between 2008 and 2013 was undertaken. Time-to-donor death (TTD) was defined as time between extubation and declaration of death.

Results: We identified 247 recipients of DCD kidneys with calculable TTDs. Mean KDRI of transplanted kidneys was 1.24 (KDPI 71%) and anoxia and head trauma were the most common injuries leading to donation. Of these 247 transplants, 208 (84.2%) were primary. Mean TTD for all donors was 28.4 min (range: 0-120 min). Of the 247 recipients, 225 (group 1) received kidneys with a TTD of 0-1 hour; 22 (group 2; 8.9%) received grafts with a TTD of 1-2 hours. Recipient diabetes was more prevalent in group 1 (p=0.018). More females were in group 2 (33.3% vs 54.6% p=0.047). KDRI was lower (1.256 vs 1.096, p<0.001), and BMI was higher in group 2 (27.7 vs 30.1, p=0.038). Cold ischemia time, donor and recipient ages, race, and pre-transplant dialysis were not different between groups 1 and 2. Five-year patient survival was 88.8% for group 1, and 83.9% for group 2, showing no significant difference (p=0.667); Graft survival was also similar between the groups, with 5 year survival of 74.1% for group 1, and 83.9% for group 2 (p=0.507). DGF rate was the same in both groups. (50.2% vs 50.0%, p=0.984). As a continuous variable, TTD was not predicative of graft failure.

Conclusions: Kidneys from donors with longer TTDs do equally as well as those with shorter TTDs. Although we have a policy to allow a TTD of 2 hours for all kidney donors at our center, the KDRI data may imply some selection bias, although it may be that donors with lower KDRIs take longer to die. Nevertheless, by waiting 2 hours for DCD kidneys, we performed 9.8% more kidney transplants without worse outcomes. If applied nationwide this would allow for 237 additional kidney transplants annually.

CITATION INFORMATION: Scalea J, Fernandez L, D'Alessandro A, Anderson M, Foley D, Mezrich J. Does DCD Donor Time-to-Death After Withdrawal of Support Affect Recipient Outcomes? Implications of Time-to-Death at a High-Volume Center in the United States. Am J Transplant. 2016;16 (suppl 3).

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