CAMBRIDGE, U.K.—Kidneys transplanted from cardiac death donors perform as well as those from brain-dead owners, according to an article published online Aug. 19 in The Lancet.
"Kidneys from controlled cardiac-death donors provide a good outcome in terms of both graft survival and graft function in first-time recipients and should be regarded as equivalent to kidneys from brain-death donors,” the authors wrote. “The factors shown to affect transplant outcome for kidneys from cardiac-death donors will help to guide clinical decision-making and inform future allocation policy."
In this study, Professor J. Andrew Bradley, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK, and colleagues looked at outcomes for kidneys after controlled cardiac death versus brain death, and aimed to identify factors affecting graft survival and function. They used data from the UK transplant registry to select a cohort of deceased kidney donors and the corresponding transplant recipients (aged ≥18 years) for transplants done between Jan 1, 2000, and Dec 31, 2007.
A total of 9,134 kidney transplants were done in 23 centers; 8,289 kidneys were donated after brain death and 845 after controlled cardiac death. First-time recipients of kidneys from cardiac-death donors (n=739) or brain-death donors (n=6,759) showed no difference in graft survival up to 5 years, or in kidney function (filtration rate) at 1 to 5 years after transplantation.
For recipients of kidneys from cardiac-death donors, increasing age of donor and recipient, repeat transplantation, and cold ischaemic time of more than 12 hours were associated with worse graft survival; grafts from cardiac-death donors that were poorly matched for HLA (a blood antigen) had a non-statistically significant association with inferior outcome, and delayed graft function and warm ischaemic time had no effect on outcome.
"The shortage of donor organs remains one of the key challenges faced by the international transplant community,” the authors wrote. “In view of our findings, cardiac-death donors represent an extremely important and overlooked source of high-quality donor kidneys for transplantation and have the potential to increase markedly the number of kidney transplants performed in the UK."
