Kidneys from Donors after Cardiac Death Provide Survival Benefit

Published ahead of print on May 20, 2010
Journal of the American Society of Nephrology
© 2010 American Society of Nephrology
doi: 10.1681/ASN.2009121203

CLINICAL EPIDEMIOLOGY

Kidneys from Donors after Cardiac Death Provide Survival Benefit

Maarten G. Snoeijs*, Douglas E. Schaubel{dagger}, Ronald Hené{ddagger}, Andries J. Hoitsma§, Mirza M. Idu||, Jan N. Ijzermans¶, Rutger J. Ploeg**, Jan Ringers{dagger}{dagger}, Maarten H. Christiaans{ddagger}{ddagger}, Wim A. Buurman* and L.W. Ernest van Heurn*

* Department of Surgery and
{ddagger}{ddagger} Department of Internal Medicine/Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands;
{dagger} Department of Biostatistics, University of Michigan, Ann Arbor, Michigan;
{ddagger} Department of Nephrology, University Medical Center Utrecht, Utrecht, Netherlands;
§ Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands;
|| Department of Surgery, Academic Medical Center, Amsterdam, Netherlands;
¶ Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands;
** Department of Surgery, University Medical Center Groningen, Groningen, Netherlands; and
{dagger}{dagger} Department of Surgery, Leiden University Medical Center, Leiden, Netherlands

Correspondence: Dr. Maarten G. Snoeijs, Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, Netherlands. Phone: +31-43-3875938; Fax: +31-43-3875478; E-mail: m.snoeijs@mumc.n

Received for publication December 1, 2009. Accepted for publication February 22, 2010.

The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool. Donation after cardiac death (DCD) increases the number of available kidneys, but it is unknown whether patients who receive a DCD kidney live longer than patients who remain on dialysis and wait for a conventional kidney from a brain-dead donor (DBD). This observational cohort study included all 2575 patients who were registered on the Dutch waiting list for a first kidney transplant between January 1, 1999, and December 31, 2004. From listing until the earliest of death, living-donor kidney transplantation, or December 31, 2005, 459 patients received a DCD transplant and 680 patients received a DBD transplant. Graft failure during the first 3 months after transplantation was twice as likely for DCD kidneys than DBD kidneys (12 versus 6.3%; P = 0.001). Standard-criteria DCD transplantation associated with a 56% reduced risk for mortality (hazard ratio 0.44; 95% confidence interval 0.24 to 0.80) compared with continuing on dialysis and awaiting a standard-criteria DBD kidney. This reduction in mortality translates into 2.4-month additional expected lifetime during the first 4 years after transplantation for recipients of DCD kidneys compared with patients who await a DBD kidney. In summary, standard-criteria DCD kidney transplantation associates with increased survival of patients who have ESRD and are on the transplant waiting list.

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J. Am. Soc. Nephrol. 2010 0: ASN.2010040415v1.

http://jasn.asnjournals.org/cgi/content/abstract/ASN.2009121203v1