Risk Associated With DCD Kidney Transplantation Varies by Donor Characteristics
Johns Hopkins, Baltimore.
Meeting: 2015 American Transplant Congress
Abstract number: 296
Keywords: Donors, Graft survival, Kidney transplantation, non-heart-beating
Session Information
Session Name: Concurrent Session: Kidney: KDPI and Non Ideal Kidneys
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 4:00pm-5:30pm
Presentation Time: 5:12pm-5:24pm
Location: Room 118-AB
Studies have shown that comparable kidney graft survival between donors after brain death (DBD) and donors after circulatory death (DCD) overall. However, the differential risk conferred by DCD status in various subgroups is poorly understood.
METHODS: We used Cox models and SRTR data to compare all-cause graft loss between DCD and DBD in adult deceased donor kidney-only transplant (KT) recipients 2000-2014, adjusting for donor, recipient and graft characteristics. Interaction terms between DCD and other characteristics were used to study effect modification.
RESULTS: Of 120,011 KT recipients, 10.6% received DCD. Unadjusted 5-year graft loss was 29.3% in DBD and 28.8% in DCD (Figure1); adjusted HR (aHR) was 1.08 1.13 1.18 (p<0.001).
Risk associated with DCD was consistent across subgroups in terms of recipient characteristics but amplified by prolonged cold ischemia time (CIT), regional/national sharing, and older donor age (Table1).
aHR (DCD) | |
Cold ischemia time | |
< 12 hours | 0.94 1.05 1.16 |
12-24 hours | 1.03 1.10 1.16 |
>24 hours | 1.18 1.28 1.39 |
Share type | |
local | 1.04 1.10 1.15 |
regional/national | 1.18 1.31 1.46 |
Donor age | |
< 40 | 1.02 1.10 1.18 |
40-60 | 1.06 1.12 1.20 |
≥ 60 | 1.12 1.30 1.50 |
Based on these characteristics, we described three groups of differential DCD-associated risk (Figure2). HR of DCD was 0.95 1.06 1.19 (p=0.3) for group 1 (DCD comparable to DBD, N=25,187), 1.00 1.07 1.13 (p=0.04) for group 2 (DCD slightly higher risk than DBD, N=61,033), and 1.19 1.29 1.40 (p<0.001) for group 3 (DCD higher risk than DBD, N=33,791).
CONCLUSIONS: Risk associated with DCD KT was consistent across recipient characteristics but varied by share type, CIT, and donor age. This interaction between DCD and other donor characteristics is a novel, important consideration not captured by the traditional "risk index" approach.
To cite this abstract in AMA style:
Luo X, Massie A, Chow E, Segev D. Risk Associated With DCD Kidney Transplantation Varies by Donor Characteristics [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-associated-with-dcd-kidney-transplantation-varies-by-donor-characteristics/. Accessed October 3, 2024.« Back to 2015 American Transplant Congress