David O Walls1, Grace S Lee-Riddle2, Michelle Bover Manderski3, Deirdre L Sawinski4, Peter L Abt2. 1. Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA. 2. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Epidemiology, Rutgers School of Public Health, New Brunswick, NJ, USA. 4. Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Continued comparison of kidney transplant outcomes between older DCD and donation after brain death (DBD) donors is needed to safely expand the deceased donor pool. METHODS: We performed a retrospective cohort study using the UNOS/OPTN transplant registry from donors >50 years old between 1994 and 2016. Donor age was stratified into 4 groups: 50-54, 55-59, 60-64, and >65 years old. Rates of delayed graft function (DGF) and primary non-function (PNF) were compared. Multivariable Cox regression models were constructed to identify factors associated with time to graft failure. RESULTS: The DCD donors within each age group had fewer comorbidities than the DBD donors. Graft survival for DCD kidneys was equivalent or superior to DBD kidneys in all donor age groups. DGF rates were significantly greater for DCD kidneys in all age groups. PNF rates across all groups were similar. In multivariable analysis, DCD status was not independently associated with time to all-cause graft failure in the 50-54 donor age group (HR = 1.02, 95% CI = 0.93-1.13), 55-59 donor age group (HR = 1.07, 95% CI = 0.96-1.19), or 60-64 donor age group (HR = 1.135, 95% CI = 0.97-1.32). CONCLUSION: Kidneys from carefully selected older DCD donors, particularly ages 50-64, are a potential means to safely expand the deceased donor pool.
BACKGROUND: Continued comparison of kidney transplant outcomes between older DCD and donation after brain death (DBD) donors is needed to safely expand the deceased donor pool. METHODS: We performed a retrospective cohort study using the UNOS/OPTN transplant registry from donors >50 years old between 1994 and 2016. Donor age was stratified into 4 groups: 50-54, 55-59, 60-64, and >65 years old. Rates of delayed graft function (DGF) and primary non-function (PNF) were compared. Multivariable Cox regression models were constructed to identify factors associated with time to graft failure. RESULTS: The DCD donors within each age group had fewer comorbidities than the DBD donors. Graft survival for DCD kidneys was equivalent or superior to DBD kidneys in all donor age groups. DGF rates were significantly greater for DCD kidneys in all age groups. PNF rates across all groups were similar. In multivariable analysis, DCD status was not independently associated with time to all-cause graft failure in the 50-54 donor age group (HR = 1.02, 95% CI = 0.93-1.13), 55-59 donor age group (HR = 1.07, 95% CI = 0.96-1.19), or 60-64 donor age group (HR = 1.135, 95% CI = 0.97-1.32). CONCLUSION: Kidneys from carefully selected older DCD donors, particularly ages 50-64, are a potential means to safely expand the deceased donor pool.
Keywords:
Donors and donation: donation after brain death (DBD); donors and donation: donation after circulatory death (DCD); graft survival; registry/registry analysis
Authors: Jan Roman; František Jalůvka; Petr Ostruszka; Petr Jelínek; Ján Hrubovčák; Pavel Havránek; Adéla Vrtková; Zdeněk Lys; Jarmila Dědochová; Václav Procházka Journal: Med Sci Monit Date: 2022-07-04