title: Comparison of kidney function between donation after cardiac death and donation after brain death kidney transplantation.
abstract: BACKGROUND
  Kidney graft survival is comparable between donation after cardiac death (DCD) and donation after brain death (DBD) kidney transplantation. However, data concerning kidney function after DCD kidney transplantation are lacking.
  
  
  METHODS
  We retrospectively compared kidney function between 64 DCD and 248 DBD kidney transplant recipients. Graft function was assessed using iothalamate glomerular filtration rate at 1, 4, and 12 months, then annually. The primary endpoint was the composite of death-censored graft loss or two consecutive iothalamate glomerular filtration rates less than 50 mL/min/1.73 m² occurring within 5 years from transplantation. Secondary endpoints included death and graft loss or death.
  
  
  RESULTS
  Of the 312 patients, 102 (33%) experienced the primary endpoint, 78 (25%) experienced graft loss or death, and 44 (14%) died. In multivariable Cox regression analysis, there was no difference between DCD and DBD recipients regarding the primary endpoint (relative risk [RR], 1.16; P=0.59), death (RR, 0.97; P=0.94), or graft loss or death (RR, 1.09; P=0.79). In the subgroup of 64 DCD recipients, each 10-year increase in donor age was associated with increased risk of the primary endpoint (RR, 1.51; P=0.027) with the highest risk observed for donors older than 45 years (RR, 4.81; P=0.001). Delayed graft function affected 45% of the DCD recipients but had no impact on kidney function, graft survival, or patient survival.
  
  
  CONCLUSIONS
  Posttransplantation kidney function is comparable between DCD and DBD kidney transplantations. In the subgroup of DCD recipients, kidneys from donors older than 45 years may be associated with a higher risk of poor kidney function; however, this finding requires validation in a larger patient group.
authors.affiliation: Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA. wadei.hani@mayo.edu
authors.forename: Hani M
authors.initials: HM
authors.lastname: Wadei
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
authors.forename: Waleed
authors.initials: W
authors.lastname: Farahat
authors.forename: Laila
authors.initials: L
authors.lastname: Nur
authors.forename: Martin L
authors.initials: ML
authors.lastname: Mai
authors.forename: Mary
authors.initials: M
authors.lastname: Prendergast
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gonwa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000503:physiopathology*; D003643:Death; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014019:Tissue Donors