Donation After Cardiac Death (DCD) Agonal Phase Physiology is Associated with Post-transplant Kidney Graft Outcomes

A. Kayastha¹, K. C. Eddinger², E. M. Sonnenberg², N. Mahmud², D. E. Schaubel¹, P. L. Abt²

¹Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, ²Hospital of the University of Pennsylvania, Philadelphia, PA

Meeting: 2021 American Transplant Congress

Abstract number: 845

Keywords: Donors, non-heart-beating, Graft failure, Kidney transplantation, Warm ischemia

Topic: Clinical Science » Kidney » Kidney Deceased Donor Selection

Session Information

Session Name: Kidney Deceased Donor Selection

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Kidneys procured from DCD donors play a key role in addressing the kidney shortage in the United States, and donor hemodynamics during obligatory warm ischemia may provide insight into graft quality and outcomes. There have been no large-scale studies evaluating these relationships.

*Methods: The UNOS registry was used to identify DCD kidney donors and their corresponding recipients. The dataset included donor and recipient demographic data, follow-up data, and agonal phase donor hemodynamic time-series data. The systolic blood pressure (SBP) and oxygen saturation (SpO₂) time-series were analyzed using various quantitative techniques, including computing slopes and areas under the curve (AUC). Asystolic time, defined as the time from when SBP reached 0 mmHg to cross-clamp, was also modeled. Univariable and multivariable logistic regression were used to analyze associations between calculated hemodynamic measures and delayed graft function (DGF), defined as whether the recipient required dialysis within one week after transplant. Univariable and multivariable Cox regression were used to evaluate analogous associations between hemodynamic measures and 90-day, 1-year, and 3-year graft failure.

*Results: Analysis was completed on 1911 DCD kidney donors between 2012 and 2018. The time beyond SBP < 50 mmHg was found to be associated with DGF in a multivariable model (OR = 1.021, p < 0.001). The slope of the SpO₂ curve demonstrated significance in a multivariable model with respect to DGF (OR = 1.030, p < 0.001). Asystolic time was found to be significantly associated with DGF and graft failure in all models (Table 1).

Summary of Asystolic Time Results, by Outcome and Model Type
	Univariable Model	Multivariable Model
DGF	OR = 1.027, p < 0.001	OR = 1.026, p < 0.001
90-day Graft Failure	HR = 1.036, p = 0.001	HR = 1.028, p = 0.019
1-year Graft Failure	HR = 1.026, p = 0.011	HR = 1.022, p = 0.037
3-year Graft Failure	HR = 1.025, p = 0.003	HR = 1.022, p = 0.012

*Conclusions: A number of hemodynamic measures are independently associated with DGF and graft failure. Greater asystolic times are associated with worse outcomes. These methods that quantify agonal phase hemodynamics are techniques that help better characterize DCD donor kidney quality and recipient graft outcomes, which may help inform organ selection and expand the donor pool.

To cite this abstract in AMA style:

Kayastha A, Eddinger KC, Sonnenberg EM, Mahmud N, Schaubel DE, Abt PL. Donation After Cardiac Death (DCD) Agonal Phase Physiology is Associated with Post-transplant Kidney Graft Outcomes [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/donation-after-cardiac-death-dcd-agonal-phase-physiology-is-associated-with-post-transplant-kidney-graft-outcomes/. Accessed May 15, 2025.

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