Donor kidney disease and transplant outcome for kidneys donated after cardiac death.
BACKGROUND
Although outcomes of kidney transplants following donation after cardiac death (DCD) and donation after brainstem death (DBD) are similar, generally only optimal younger DCD donors are considered. This study examined the impact of pre-existing donor kidney disease on the outcome of DCD transplants.


METHODS
This retrospective study compared the outcome of all DCD kidney transplants performed during 1996-2006 with contemporaneous kidney transplants from DBD donors. Implantation biopsies were scored for glomerular, tubular, parenchymal and vascular disease (global histology score). There were 104 DCD and 104 DBD kidney transplants.


RESULTS
Delayed graft function (DGF) occurred more frequently in DCD than DBD kidneys (64.4 versus 28.8 per cent; P < 0.001). Long-term graft outcome was similar. The only donor factor that influenced outcome was baseline kidney disease, which was similar in both groups, even though DCD donors were younger, with a higher predonation estimated glomerular filtration rate. The global histology score predicted DGF (odds ratio 1.85 per unit; P = 0.006) and graft failure (relative risk 1.55 per unit; P = 0.001), although there was no difference for DCD and DBD kidneys.


CONCLUSIONS
Transplant outcomes for DCD and DBD kidneys are comparable. Baseline donor kidney disease influences DGF and graft survival but the impact is no greater for DCD kidneys.
Wells
A C
AC
University of Cambridge Department of Surgery and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK. acw46@cam.ac.uk
Rushworth
L
L
Thiru
S
S
Sharples
L
L
Watson
C J E
CJ
Bradley
J A
JA
Pettigrew
G J
GJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death; D002648:Child; D003643:Death; D051799:Delayed Graft Function; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome