Does DCD Donor Time‐to‐Death Affect Recipient Outcomes? Implications of Time‐to‐Death at a High‐Volume Center in the United States

• Published in: American journal of transplantation Vol. 17; no. 1; pp. 191 - 200
• Main Authors: Scalea, J. R., Redfield, R. R., Arpali, E., Leverson, G. E., Bennett, R. J., Anderson, M. E., Kaufman, D. B., Fernandez, L. A., D'Alessandro, A. M., Foley, D. P., Mezrich, J. D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-01-2017
• Subjects: Adult; Brain Death; clinical research/practice; Death; Donor Selection; donors and donation: deceased; donors and donation: donation after circulatory death (DCD); Female; Follow-Up Studies; Glomerular Filtration Rate; Graft rejection; Graft Rejection - prevention & control; Graft Survival; Grafts; health services and outcomes research; Heart Arrest; Hospitals, High-Volume; Humans; Kidney Failure, Chronic - surgery; Kidney Function Tests; Kidney Transplantation; kidney transplantation/nephrology; Kidney transplants; Kidneys; Male; Middle Aged; organ allocation; organ procurement; organ procurement and allocation; organ procurement organization; Prognosis; Registries; Retrospective Studies; Risk Factors; Time Factors; Tissue and Organ Procurement - methods; Tissue and Organ Procurement - statistics & numerical data; Tissue Donors - statistics & numerical data; United States; organ procurement; organ procurement organization; clinical research/practice; kidney transplantation/nephrology; organ procurement and allocation; donors and donation: deceased; donors and donation: donation after circulatory death (DCD); organ allocation; health services and outcomes research
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13948

For donation after circulatory death (DCD), many centers allow 1 h after treatment withdrawal to donor death for kidneys. Our center has consistently allowed 2 h. We hypothesized that waiting longer would be associated with worse outcome. A single‐center, retrospective analysis of DCD kidneys transplanted between 2008 and 2013 as well as a nationwide survey of organ procurement organization DCD practices were conducted. We identified 296 DCD kidneys, of which 247 (83.4%) were transplanted and 49 (16.6%) were discarded. Of the 247 recipients, 225 (group 1; 91.1%) received kidneys with a time to death (TTD) of 0–1 h; 22 (group 2; 8.9%) received grafts with a TTD of 1–2 h. Five‐year patient survival was 88.8% for group 1, and 83.9% for group 2 (p = 0.667); Graft survival was also similar, with 5‐year survival of 74.1% for group 1, and 83.9% for group 2 (p = 0.507). The delayed graft function rate was the same in both groups (50.2% vs. 50.0%, p = 0.984). TTD was not predictive of graft failure. Nationally, the average maximum wait‐time for DCD kidneys was 77.2 min. By waiting 2 h for DCD kidneys, we performed 9.8% more transplants without worse outcomes. Nationally, this practice would allow for hundreds of additional kidney transplants, annually.
Hundreds more kidney transplants could be performed in the United States each year if centers were willing to wait up to 2 hours for kidneys procured after circulatory death, with no decrease in outcome.