TY - JOUR
T1 - Survival benefit of accepting kidneys from older donation after cardiac death donors
AU - Yu, Sile
AU - Long, Jane J.
AU - Yu, Yifan
AU - Bowring, Mary G.
AU - Motter, Jennifer D.
AU - Ishaque, Tanveen
AU - Desai, Niraj
AU - Segev, Dorry L.
AU - Garonzik-Wang, Jacqueline M.
AU - Massie, Allan B.
N1 - Funding Information:
The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was supported by grant numbers: K01DK101677 (Massie), K24DK101828 (Segev), and K23DK115908 (Garonzik-Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr Garonzik-Wang is supported by a Clinician Scientist Development Award from the Doris Duke Charitable Foundation.
Funding Information:
The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was supported by grant numbers: K01DK101677 (Massie), K24DK101828 (Segev), and K23DK115908 (Garonzik‐Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr Garonzik‐Wang is supported by a Clinician Scientist Development Award from the Doris Duke Charitable Foundation.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/3
Y1 - 2021/3
N2 - Kidneys from older (age ≥50 years) donation after cardiac death (DCD50) donors are less likely to be transplanted due to inferior posttransplant outcomes. However, candidates who decline a DCD50 offer must wait for an uncertain future offer. To characterize the survival benefit of accepting DCD50 kidneys, we used 2010-2018 Scientific Registry for Transplant Recipients (SRTR) data to identify 92 081 adult kidney transplantation candidates who were offered a DCD50 kidney that was eventually accepted for transplantation. DCD50 kidneys offered to candidates increased from 590 in 2010 to 1441 in 2018. However, 34.6% of DCD50 kidneys were discarded. Candidates who accepted DCD50 offers had 49% decreased mortality risk (adjusted hazard ratio [aHR] 0.460.510.55, cumulative mortality at 6-year 23.3% vs 34.0%, P <.001) compared with those who declined the same offer (decliners). Six years after their initial DCD50 offer decline, 43.0% of decliners received a deceased donor kidney transplant (DDKT), 6.3% received living donor kidney transplant (LDKT), 22.6% died, 22.0% were removed for other reasons, and 6.0% were still on the waitlist. Comparable survival benefit was observed even with DCD donors age ≥60 (aHR: 0.420.520.65, P <.001). Accepting DCD50 kidneys was associated with a substantial survival benefit; providers and patients should consider these benefits when evaluating offers.
AB - Kidneys from older (age ≥50 years) donation after cardiac death (DCD50) donors are less likely to be transplanted due to inferior posttransplant outcomes. However, candidates who decline a DCD50 offer must wait for an uncertain future offer. To characterize the survival benefit of accepting DCD50 kidneys, we used 2010-2018 Scientific Registry for Transplant Recipients (SRTR) data to identify 92 081 adult kidney transplantation candidates who were offered a DCD50 kidney that was eventually accepted for transplantation. DCD50 kidneys offered to candidates increased from 590 in 2010 to 1441 in 2018. However, 34.6% of DCD50 kidneys were discarded. Candidates who accepted DCD50 offers had 49% decreased mortality risk (adjusted hazard ratio [aHR] 0.460.510.55, cumulative mortality at 6-year 23.3% vs 34.0%, P <.001) compared with those who declined the same offer (decliners). Six years after their initial DCD50 offer decline, 43.0% of decliners received a deceased donor kidney transplant (DDKT), 6.3% received living donor kidney transplant (LDKT), 22.6% died, 22.0% were removed for other reasons, and 6.0% were still on the waitlist. Comparable survival benefit was observed even with DCD donors age ≥60 (aHR: 0.420.520.65, P <.001). Accepting DCD50 kidneys was associated with a substantial survival benefit; providers and patients should consider these benefits when evaluating offers.
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - clinical decision-making
KW - clinical research/practice
KW - donors and donation: donation after circulatory death (DCD)
KW - epidemiology
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - organ procurement and allocation
KW - patient survival
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U2 - 10.1111/ajt.16198
DO - 10.1111/ajt.16198
M3 - Article
C2 - 32659036
AN - SCOPUS:85091003748
VL - 21
SP - 1138
EP - 1146
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 3
ER -