title: Survival of Kidney Allograft of Donors after Circulatory Death Is Similar to Donors after Brain Death: Experience in a Regional Program.
abstract: BACKGROUND
  Donors after circulatory death (DCD) are an increasingly crucial source of organs to maintain deceased donor kidney transplant activity when faced with a standstill in donors after brain death (DBD). We analyzed the influence on graft survival since the use of DCD organs was implemented in Andalusia (2010-2014).
  
  
  METHODS
  We compared 164 kidney transplants from DCD (83 Maastricht type II and 81 type III) and 1488 DBD transplants in recipients over the age of 18, excluding combined transplants.
  
  
  RESULTS
  DCD were more frequently men from the A blood group who were younger (48.9 ± 11 vs 55.2 ± 15 years old for DBD, P < .001). Kidneys from DCD were implanted in younger recipients (51.2 ± 11 vs 53.5 ± 13 years old for DBD, P = .03), more frequently in men from blood group A who spent less time in renal replacement therapy (39.8 vs 51.5 months), in a lower proportion of immunized recipients and re-transplant patients, and had worse HLA-DR compatibility. DCD presented a proportion of primary nonfunctional allografts and an initial need for dialysis of 8.8% and 69.6% vs 5.5% and 29.6% for DBD (P < .001). DCD allograft recipient survival was 96% and 96% at the first and third year respectively, vs 96% and 93% with a DBD graft (NS). Survival of the graft was 91% and 86% at the 1(st) and 3(rd) years, vs 90% and 86% with a DBD allograft (NS). No significant difference was found between Maastricht type II and III. DCD were related to lower graft survival versus DBD under the age of 50 (n = 445), 86% vs 92% (P = .02) in the third year, but were similar to DBD from age 50 to 59 (n = 407) and higher than DBD over age 60 (n = 636), 80% at the 3(rd) year (NS). The survival of DCD recipients was not different than DBD in those under 60 and was significantly better than DBD at or over the age of 60 (96% vs 87% in the 3(rd) year, P = .036). In the multivariable survival study (Cox, covariates of influence previously demonstrated in our region) DCD are not a significant survival prognosis factor for the recipient or the allograft.
  
  
  CONCLUSIONS
  With the current guidelines of donor selection and allocation of organs applied in Andalusia, the survival of kidney transplants from DCD overall is similar to DBD. The graft performance tends to be better than DBD over the age of 60, the main source of donors at present.
authors.affiliation: Nephrology Department, Hospital Universitario Hospital U, Virgen del Rocío, Sevilla, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil
authors.affiliation: Coordinación Autonómica de Trasplantes, Andalucía, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Castro
authors.affiliation: Nephrology Department, Hospital Universitario Hospital U, Virgen del Rocío, Sevilla, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Ballesteros
authors.affiliation: Nephrology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Gracia-Guindo
authors.affiliation: Nephrology Department, Hospital Universitario Hospital U. Regional de Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cabello
authors.affiliation: Nephrology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Mazuecos
authors.affiliation: Nephrology Department, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez-Benot
authors.affiliation: Nephrology Department, Hospital Universitario Hospital U, Virgen del Rocío, Sevilla, Spain. Electronic address: cgonzalezcorvillo@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Gonzalez-Corvillo
authors.affiliation: Nephrology Department, Hospital Universitario Ciudad de Jaén, Jaén, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Borrego
authors.affiliation: Nephrology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: A O
authors.initials: AO
authors.lastname: Ortega
authors.affiliation: Coordinación Autonómica de Trasplantes, Andalucía, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000367:Age Factors; D064591:Allografts / Q000276:immunology* / Q000637:transplantation; D001926:Brain Death; D002423:Cause of Death; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006323:Heart Arrest; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013030:Spain; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous