Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study

• Published in: The Lancet (British edition) Vol. 381; no. 9868; pp. 727 - 734
• Main Authors: Summers, Dominic M, MBBChir, Johnson, Rachel J, MSc, Hudson, Alex, MSc, Collett, David, Prof, Watson, Christopher J, Prof, Bradley, J Andrew, Prof
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 02-03-2013; Elsevier; Elsevier Limited
• Subjects: Adult; Age; Age Factors; Biological and medical sciences; biomedical research; blood; Blood & organ donations; Brain; Brain Death; Cause of Death; Chi-Square Distribution; cohort studies; cold; cold storage; Cold Temperature; death; Female; General aspects; Graft Survival; Humans; Internal Medicine; ischemia; issues and policy; Kaplan-Meier Estimate; kidney transplant; Kidney transplantation; Kidney Transplantation - methods; kidneys; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Organ Preservation - methods; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; risk; Statistics, Nonparametric; storage time; Survival; Time Factors; Tissue Donors; Tissue Survival; Transplants & implants; United Kingdom; United Kingdom; Europe; United Kingdom > UK; Human; Prognosis; Storage time; Mortality; Recipient; Cold storage; Kidney; Medicine; Urinary system; Donor; Cohort study; Evolution; Death; Age; Public health
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(12)61685-7

Summary Background Use of kidneys donated after controlled circulatory death has increased the number of transplants undertaken in the UK but there remains reluctance to use kidneys from older circulatory-death donors and concern that kidneys from circulatory-death donors are particularly susceptible to cold ischaemic injury. We aimed to compare the effect of donor age and cold ischaemic time on transplant outcome in kidneys donated after circulatory death versus brain death. Methods We used the UK transplant registry to select a cohort of first-time recipients (aged ≥18 years) of deceased-donor kidneys for transplantations done between Jan 1, 2005, and Nov 1, 2010. We did univariate comparisons of transplants from brain-death donors versus circulatory-death donors with χ2 tests for categorical data and Wilcoxon tests for non-parametric continuous data. We used Kaplan-Meier curves to show graft survival. We used Cox proportional hazards regression to adjust for donor and recipient factors associated with graft-survival with tests for interaction effects to establish the relative effect of donor age and cold ischaemia on kidneys from circulatory-death and brain-death donors. Findings 6490 deceased-donor kidney transplants were done at 23 centres. 3 year graft survival showed no difference between circulatory-death (n=1768) and brain-death (n=4127) groups (HR 1·14, 95% CI 0·95–1·36, p=0·16). Donor age older than 60 years (compared with <40 years) was associated with an increased risk of graft loss for all deceased-donor kidneys (2·35, 1·85–3·00, p<0·0001) but there was no increased risk of graft loss for circulatory-death donors older than 60 years compared with brain-death donors in the same age group (p=0·30). Prolonged cold ischaemic time (>24 h vs <12 h) was not associated with decreased graft survival for all deceased-donor kidneys but was associated with poorer graft survival for kidneys from circulatory-death donors than for those from brain-death donors (2·36, 1·39–4·02, p for interaction=0·004). Interpretation Kidneys from older circulatory-death donors have equivalent graft survival to kidneys from brain-death donors in the same age group, and are acceptable for transplantation. However, circulatory-death donor kidneys tolerate cold storage less well than do brain-death donor kidneys and this finding should be considered when developing organ allocation policy. Funding UK National Health Service Blood and Transplant; Cambridge National Institute for Health Research Biomedical Research Centre.