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Schaapherder A, Wijermars LGM, de Vries DK, et al. Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation. EClinicalMedicine. 2018;4:25-31doi: 10.1016/j.eclinm.2018.09.007.
Schaapherder, A., Wijermars, L. G. M., de Vries, D. K., de Vries, A. P. J., Bemelman, F. J., van de Wetering, J., van Zuilen, A. D., Christiaans, M. H. L., Hilbrands, L. H., Baas, M. C., Nurmohamed, A. S., Berger, S. P., Alwayn, I. P., Bastiaannet, E., & Lindeman, J. H. N. (2018). Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation. EClinicalMedicine, 425-31. https://doi.org/10.1016/j.eclinm.2018.09.007
Schaapherder, Alexander, et al. "Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation." EClinicalMedicine vol. 4 (2018): 25-31. doi: https://doi.org/10.1016/j.eclinm.2018.09.007
Schaapherder A, Wijermars LGM, de Vries DK, de Vries APJ, Bemelman FJ, van de Wetering J, van Zuilen AD, Christiaans MHL, Hilbrands LH, Baas MC, Nurmohamed AS, Berger SP, Alwayn IP, Bastiaannet E, Lindeman JHN. Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation. EClinicalMedicine. 2018 Oct 09;4:25-31. doi: 10.1016/j.eclinm.2018.09.007. eCollection 2018. PMID: 31193600; PMCID: PMC6537547.
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EClinicalMedicine. 2018 Oct 09;4:25-31. doi: 10.1016/j.eclinm.2018.09.007. eCollection 2018.

Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation.

EClinicalMedicine

Alexander Schaapherder, Leonie G M Wijermars, Dorottya K de Vries, Aiko P J de Vries, Frederike J Bemelman, Jacqueline van de Wetering, Arjan D van Zuilen, Maarten H L Christiaans, Luuk H Hilbrands, Marije C Baas, Azam S Nurmohamed, Stefan P Berger, Ian P Alwayn, Esther Bastiaannet, Jan H N Lindeman

Affiliations

  1. Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands.
  2. Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
  3. Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands.
  4. Department of Nephrology, Erasmus University Medical Center Rotterdam, the Netherlands.
  5. Department of Nephrology, University Medical Center Utrecht, the Netherlands.
  6. Department of Nephrology, Maastricht University Medical Center, the Netherlands.
  7. Department of Nephrology, Radboud University Medical Center, the Netherlands.
  8. Department of Nephrology, VU Medical Center, the Netherlands.
  9. Department of Nephrology, University Medical Center Groningen, the Netherlands.
  10. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.

PMID: 31193600 PMCID: PMC6537547 DOI: 10.1016/j.eclinm.2018.09.007

Abstract

BACKGROUND: Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified.

METHODS: This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses.

FINDINGS: Despite higher incidences of early graft loss (+ 50%) and delayed graft function (+ 250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5-75.2), combined recipient survival: 64.5% (95 CI: 63.0-66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55-0.87), p < 0.001). Mid and long-term graft function (eGFR), and the impact of incident delayed graft function on eGFR were similar for DBD and DCD grafts.

INTERPRETATION: Mid and long term outcomes for DCD grafts are equivalent to DBD kidneys. Poorer short term outcomes are offset by a lesser impact of delayed graft function on DCD graft survival. This nation-wide evaluation does not justify the reluctance to use of DCD renal grafts. A strong focus on short-term outcome neglects the superior recovery potential of DCD grafts.

Keywords: Delayed graft function; Donation after brain death; Donation after cardiac death; Graft survival; Kidney transplantation; Outcome

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