Donation After Circulatory Death Kidney Transplantation Has Equal Long-Term Graft and Patient Survival as Donation After Brain Death: A Systematic Review and Meta-Analysis

E. Rijkse¹, S. Ceuppens¹, H. Qi², J. N. IJzermans¹, D. A. Hesselink³, R. C. Minnee¹

¹HPB/Transplant surgery, Erasmus Medical Center, Rotterdam, Netherlands, ²Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands, ³Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, Netherlands

Meeting: 2021 American Transplant Congress

Abstract number: 858

Keywords: Donors, non-heart-beating, Graft acceptance, Graft survival, Meta-analysis

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: Donation after circulatory death (DCD) kidneys are not worldwide accepted yet due to concerns about inferior quality. To investigate whether these concerns are justified, a meta-analysis was performed to assess DCD graft survival compared to donation after brain death (DBD) graft survival. Secondary outcomes were the risk of primary non-function (PNF), delayed graft function (DGF), acute rejection (AR) within 3 months, 1-year estimated Glomerular Filtration Rate (eGFR), patient survival, and risk of urologic complications.

*Methods: EMBASE, Medline, Cochrane, Web of Science and Google Scholar databases were searched for studies published until September 15^th, 2020. Studies comparing DCD to DBD for any of the outcomes were included. Exclusion criteria were: studies using normothermic machine perfusion or regional perfusion and studies reporting on pediatric/dual kidney transplants. A random-effects model was used for meta-analysis. Meta-regression analysis was performed if I² exceeded 50%.

*Results: 1808 studies were screened, 51 studies were included. The risk of 1-year all-cause and death-censored graft loss was increased in DCD recipients (risk ratio (RR) 1.13 (1.08-1.19) and RR 1.10 (1.04-1.16)). The risk of 10-year all-cause and death-censored graft loss (RR 1.03 (0.94-1.13) and RR 1.02 (0.92-1.13)) was equal to DBD recipients. DCD recipients had a higher risk of PNF (RR 1.43 (1.26-1.62)) and DGF (RR 2.02 (1.88-2.16)). The risk of AR and 1-year eGFR was similar to DBD. One-year mortality risk was increased in DCD recipients (RR 1.10 (1.01-1.21), while the 5-year and 10-year mortality risk were similar to DBD. The risk of ureter leakage/stenosis was not significantly different.

*Conclusions: DCD kidney transplant recipients have similar long-term graft and patient survival as DBD recipients despite a higher risk of PNF and a higher risk of mortality and graft loss in the first year. These results should encourage implementation of DCD programs worldwide to increase the donor pool.

To cite this abstract in AMA style:

Rijkse E, Ceuppens S, Qi H, IJzermans JN, Hesselink DA, Minnee RC. Donation After Circulatory Death Kidney Transplantation Has Equal Long-Term Graft and Patient Survival as Donation After Brain Death: A Systematic Review and Meta-Analysis [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/donation-after-circulatory-death-kidney-transplantation-has-equal-long-term-graft-and-patient-survival-as-donation-after-brain-death-a-systematic-review-and-meta-analysis/. Accessed June 1, 2025.

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