Abstract
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.
Original language | English (US) |
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Journal | American Journal of Transplantation |
DOIs | |
State | Accepted/In press - 2020 |
Keywords
- clinical decision-making
- clinical research/practice
- donors and donation: donation after circulatory death (DCD)
- epidemiology
- health services and outcomes research
- kidney transplantation/nephrology
- organ procurement and allocation
- patient survival
- Scientific Registry for Transplant Recipients (SRTR)
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)