Outcomes of Kidney Transplant Recipients (KTRs) Comparing Brain Dead Donors’ vs Donation After Cardiac Death Stratified by KDPI, Focus on Marginal Kidneys: A UNOS Database Analysis
1Allegheny Health Network, Pittsburgh, PA, 2UPMC, Pittsburgh, PA, 3University Hospital Marqués de Valdecilla, Santander, Spain
Meeting: 2021 American Transplant Congress
Abstract number: 131
Keywords: Cadaveric organs, Donors, non-heart-beating, Kidney transplantation, Outcome
Topic: Clinical Science » Kidney » Kidney Deceased Donor Selection
Session Information
Session Name: Kidney Deceased Donor Selection
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 6, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 4:55pm-5:00pm
Location: Virtual
*Purpose: In deceased donor kidney transplantation (DDKT), donation after cardiac death (DCD) is associated with increased cytokine release and renal tubular injury with consequent increase in the risk for delayed graft function (DGF). These cascade of events could increase acute rejection (AR) risk and potentially impact graft and patient survival. The impact of donation after brain death (DBD) vs DCD status on the long term outcomes following DDKT has conflicting reports in the literature especially for transplants from marginal donors. The aim of this study was to compare the outcomes of DDKT from DBD vs DCD in groups stratified by different degrees of kidney donor profile index (KDPI).
*Methods: Using OPTN/UNOS database, we identified adult DDKT recipients from 2005 to 2019 who received induction followed by calcinurine inhibitor/mycophenolate mofetil maintenance. Patients were divided into 4 KDPI groups: 0-20%, 21-50%, 51-84% and ≥85%. In each KDPI category, short and long-term outcomes including DGF, AR, adjusted overall graft, death-censored graft, and patient survivals were compared between patients who received kidneys from DBD vs DCD donors.
*Results: There were 99548 DDKT recipients included in the study. Outcomes are shown in Table 1. Utilization of machine perfusion and the incidence of DGF were higher for kidneys from DCD donors across all KDPI groups (***=p <0.0001). The AR rates and patient survivals were similar for DBD vs DCD in all KDPI categories. The overall graft and death-censored graft survivals were similar in all KDPI categories except in 21-50% KDPI group, where DBD group had better outcomes (**= p<0.05). In particular, graft (over all and death-censored) and patient survivals were similar for DBD vs. DCD kidney recipients among the high KDPI (≥85%) group.
| KDPI (0-20%) N= 33581 | KDPI (21-50%) N= 23400 | KDPI (51-84%) N=33896 | KDPI ≥ 85% N= 8671 | |
| DBD= 27739 vs DCD=5842 | DBD= 20900 vs DCD=2500 | DBD=27,718 vs DCD=6178 | DBD= 7792 vs DCD= 879 | |
| Machine perfusion (%) | 24.5% vs. 46.4% *** | 15.7% vs. 40.6% *** | 19.3% vs. 43.4% *** | 34.4% vs 48.8% *** |
| Delayed Graft Failure (%) | 27.3% vs. 45.5% *** | 14.9% vs. 32.9% *** | 22.7% vs. 42.8% *** | 29.9% vs. 48.2% *** |
| Acute Rejection (%) | 6.4% vs. 6.3% | 5.1% vs. 5.5% | 5.8% vs. 6.4% | 7.5% vs. 6.1% |
| Adjusted Graft Survival [HR(95%CI)] | 0.99 (0.94-1.05) | 1.12 (1.01-1.23) ** | 1.00 (0.94-1.07) | 1.02 (0.94-1.07) |
| Adjusted Death censored Graft Survival [HR(95%CI)] | 1.02 (0.94-1.1) | 1.21 (1.06-1.39) ** | 1.02 (0.93-1.12) | 1.03 (0.85-1.19) |
| Adjusted Patient Survival [HR(95%CI)] | 1.04 (0.96-1.1) | 0.94 (0.83-1.07) | 1.02(0.94-1.1) | 0.99 (0.86-1.15) |
*Conclusions: Despite the increased incidence of DGF in DCD kidney recipients, long-term graft and patient outcomes were similar between DBD and DCD groups across KDPI categories. This observation is particularly important in the highest KDPI group where there is still higher rates of organ discard. Our findings support more robust utilization of kidneys from DCD donors for transplantation especially from the higher KDPI groups in order to alleviate existing organ shortage.
To cite this abstract in AMA style:
Chopra B, Sureshkumar KK, Rajasundaram D, Rodrigo EC. Outcomes of Kidney Transplant Recipients (KTRs) Comparing Brain Dead Donors’ vs Donation After Cardiac Death Stratified by KDPI, Focus on Marginal Kidneys: A UNOS Database Analysis [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-kidney-transplant-recipients-ktrs-comparing-brain-dead-donors-vs-donation-after-cardiac-death-stratified-by-kdpi-focus-on-marginal-kidneys-a-unos-database-analysis/. Accessed November 21, 2024.« Back to 2021 American Transplant Congress