Survival benefit of accepting kidneys from older donation after cardiac death donors

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](0.46)0.51(0.55), 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:(0.42)0.52(0.65),P < .001). Accepting DCD50 kidneys was associated with a substantial survival benefit; providers and patients should consider these benefits when evaluating offers.

Automated summary

The study demonstrates that accepting kidneys from donors aged 50 or older after cardiac death can significantly decrease the mortality risk for recipients, with comparable survival benefits to other donor types. After declining DCD50 kidneys, some candidates still received kidney transplants from other sources at a lower survival rate.