Background: Kidneys obtained from donation after cardiac death (DCD) are being increasingly used to meet rising demand in the US. We hypothesized that outcomes from controlled DCD (cDCD) and uncontrolled DCD (uDCD) kidneys would be comparable.

Methods: Using the SRTR database we analyzed all patients undergoing kidney transplant in the US between 2000 and 2011 (n= 212,532), comparing patient and allograft outcomes among standard criteria donor (SCD), expanded criteria donor (ECD), cDCD (n= 10,713) and uDCD (n=481) organ recipients. Multivariate modeling was used to adjust for donor and recipient characteristics of age, gender, race, presence of diabetes, recipient PRA, and donor cause of death.

Results: uDCD kidneys had higher rates of delayed graft function (DGF) (50.5%) compared to cDCD (40.5%), ECD (33%), and SCD (22.6%) kidneys. Graft loss within the first 30 days was also seen at higher rates among uDCD transplants (7.9%) compared to cDCD (4.1%), ECD (6%), and SCD (4.7%) transplants. The unadjusted risk of graft loss compared to SCD kidneys was similar for cDCD (HR 0.935, CI 0.898-0.973) and uDCD kidneys (HR 1.072, CI 0.923-1.244). Multivariate modeling revealed worse allograft survival outcomes for uDCD kidneys (HR 1.354, CI 1.150-1.594) compared to cDCD kidneys (HR 0.974, CI 0.930-1.020). Overall patient survival was similar for cDCD (HR 1.066, CI 1.009-1.126) and uDCD (HR 1.035, CI 0.836-1.280) organ recipients as compared to SCD recipients. Adjusting for donor and recipient characteristics revealed decreased patient survival rates for uDCD recipients (HR 1.141, CI 0.899-1.448) compared to cDCD recipients (HR 0.934, CI 0.877-0.995).

Conclusions: Though short-term outcomes were worse for uDCD donors compared to cDCD donors, long-term outcomes including patient and allograft survival were only slightly less favorable. uDCD kidneys represent an underutilized donor pool and should be used to address the growing organ shortage.

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