Comparison of Graft Outcome Between Donation After Circulatory Death and Living-Donor Kidney Transplantation

Donation after cardiac death (DCD) and living-donor (LD) kidney transplantation are the main kidney transplantation types in China. But the outcome of DCD kidney transplantation compared with LD kidney transplantation remains unclear. In this study, 325 DCD and 409 LD kidney transplantations were included. We retrospectively compared 3-year graft survival, death-censored graft survival, recipient survival, and graft function. All kidneys of the DCD group were procured from voluntary donation after the citizens' death by the Organ Procurement Organization (OPO) in the presence of the Red Cross, and the transplantation application was approved by the Organ Transplant Ethics Committee. The graft function at year 3 in the DCD group was superior to that of the LD group (eGFR: 71.14±22.28 vs 64.29±16.76 mL/min/1.73 m2; P < .001). After matching donor age, there was no significant difference between the paired DCD and LD group (eGFR: 62.22±18.50 vs 66.99±17.81 mL/min/1.73 m2; P = .068). The 3-year graft survival (94.7% vs 97.4%; P = .041) and recipient survival (97.2% vs 99.5%; P = .011) were a little worse in the total DCD group. However, once the DCD kidney transplantation recipients survived more than 2 months, graft and recipient survival rates were similar between the DCD and LD groups (97.7% vs 97.4%, P = .866 and 99.5% vs 99.0%, P = .466). These results were confirmed in an age-paired groups study. Severe infection was the main cause of graft loss and recipient death in the early stage of DCD transplantation. Medium- and long-term graft function of DCD kidney transplantation were comparable to LD kidney transplantation. Our results supported the continued use of DCD kidneys.