*Purpose: Uncontrolled donation after cardiac death (uDCD) represents an underutilized source of donors in the United States. However, controversy surrounding the long-term durability of uDCD kidney allografts compared to controlled DCD (cDCD) and brain death (DBD) allografts have stymied their acceptance amongst transplant providers. As such the aim of this study was to explore the long-term outcomes following uDCD kidney transplantation in the United States.

*Methods: All kidney transplants performed between January 1988 and December 2017 in the OPTN/UNOS database were analyzed. Retrospective cohorts included the following patient groups: uDCD, and controlled DCD (cDCD) and deceased donation after brain death (DBD) kidney transplantation recipients. Kaplan-Meier method was used to analyze graft and patient survival. Cox regression models were utilized to describe adjusted effects of donor/recipient covariates.

*Results: There were 599 uDCD, 23,534 cDCD, and 434,603 DBD kidney transplants were performed during the study period. Ten year graft survival was inferior following uDCD compared to DBD transplantation (47% [uDCD] vs. 51% [DBD], P=0.01 ), but similar to cDCD transplantation (47% [uDCD] vs. 48% [cDCD], P=0.21). Ten year patient survival was also slightly inferior following uDCD compared to DBD transplantation (59% [uDCD] vs. 64% [DBD], P=0.04 ), but similar to cDCD transplantation (59% [uDCD] vs. 59% [cDCD], P=0.32)

*Conclusions: Although 10 year patient and graft survival were inferior following uDCD compared to DBD kidney transplantation, both outcome measures were similar to that of cDCD transplantation. Long term durability of uDCD kidney allografts is evident, and should not deter transplantation centers when seeking to expand their donor pool. Further research is needed to explore strategies to expand uDCD transplantation in the United States.

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