*Purpose: Donor hypoperfusion before asystole in renal transplants from donors after circulatory death (DCD) has been considered responsible for worse outcomes than those from donors after brain death (DBD). We assessed how the duration of hypoperfusion phase [hypoperfusion warm ischaemia time (HWIT)] affects the outcomes of DCD renal transplants.

*Methods: We included 10309 adult renal transplants (7128 DBD, 3181 DCD) (01/01/2010-31/12/2016) from the UK Transplant Registry. We divided DCD renal transplants in groups according to HWIT. We compared delayed graft function (DGF) rates, primary non-function (PNF) rates and graft survival among them using DBD renal transplants as reference group.

*Results: DGF rate was 21.7% for DBD cases, whereas it was around 40% for DCD cases with HWIT shorter than 30 min (0-10 min: 42.1%, 11-20 min: 43%, 21-30 min: 38.4%) and it was 60% for DCD cases with HWIT longer than 30 min (p<0.001). All DCD groups showed higher DGF risk when compared with DBD renal transplants in logistic regression analysis also (0-10 min: OR=2.686, 95%CI: 2.352-3.068, p<0.001, 11-20 min: OR=2.531, 95%CI: 2.003-3.198, p<0.001, 21-30 min: OR=1.764, 95%CI: 1.017-3.059, p=0.043, >30 min: OR=5.814, 95%CI: 2.798-12.081, p<0.001). The highest risk for DGF in DCD renal transplants with HWIT more than 30 min was again confirmed by logistic regression analysis when it was compared with that of the other groups (compared with DBD: OR=5.814, 95%CI: 2.798-12.081, p<0.001; compared with DCD: 0-10 min: OR=2.165, 95%CI: 1.038-4.505, p=0.039; 11-20 min: OR=2.299, 95%CI: 1.075-4.902, p=0.032; 21-30 min: OR=3.3, 95%CI: 1.33-8.197, p=0.01). No statistically significant differences were detected regarding PNF rates (p=0.713) or graft survival (p=0.757), which was confirmed by multivariate analysis.

*Conclusions: HWIT of more than 30 min increases the risk for DGF greatly, but without affecting the possibility of PNF or the graft survival.

« Back to 2021 American Transplant Congress