The differential impact of early graft dysfunction in kidney donation after brain death and after circulatory death: Insights from the Dutch National Transplant Registry

Thei S Steenvoorden; Lara Evers; Liffert Vogt; Janneke A J Rood; Jesper Kers; Marije C Baas; Maarten H L Christiaans; Jan H N Lindeman; Jan-Stephan F Sanders; Aiko P J de Vries; Arjan D van Zuilen; Frederike J Bemelman; Hessel Peters-Sengers

doi:10.1016/j.ajt.2024.09.030

The differential impact of early graft dysfunction in kidney donation after brain death and after circulatory death: Insights from the Dutch National Transplant Registry

Am J Transplant. 2024 Sep 27:S1600-6135(24)00599-9. doi: 10.1016/j.ajt.2024.09.030. Online ahead of print.

Affiliations

¹ Department of Internal Medicine, Section Nephrology, Amsterdam UMC, location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: [email protected].
² Department of Internal Medicine, Section Nephrology, Amsterdam UMC, location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Internal Medicine, Section Nephrology, Amsterdam UMC, location VUmc, Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands.
⁴ Department of Pathology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Biomolecular Systems Analytics, Van 't Hoff Institute for Molecular Sciences (HIMS), University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶ Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁷ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
⁹ Department of Medicine, Division of Nephrology, and Leiden Transplant Center, Leiden University Medical Center and Leiden University, Leiden, The Netherlands.
¹⁰ Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, The Netherlands.
¹¹ Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands.

PMID: 39343037
DOI: 10.1016/j.ajt.2024.09.030

Abstract

Kidneys donated after circulatory death (DCD) perform similarly to kidneys donated after brain death (DBD). However, the respective incidences of delayed graft function (DGF) differ. This questions the donor type-specific impact of early graft function on long-term outcomes. Using competing risk and Cox-regression analysis, we compared death-censored graft loss between types of early graft function: DGF (temporary dialysis dependency started within 7 days after transplantation), slow graft function (3-day plasma creatinine decline less than 10% per day), and immediate graft function. In 1061 DBD and 1605 DCD graft recipients (January 2014 until January 2023), graft survival was similar. DGF was associated with death-censored graft loss in DBD and DCD (adjusted hazard ratios: DGF in DBD: 1.79 [1.04-2.91], P = .027, DGF in DCD: 1.84 [1.18-2.87], P = .008; Reference: no DGF). Slow graft function was associated with death-censored graft loss in DBD, but not significantly in DCD (adjusted hazard ratios DBD: 2.82 (1.34-5.93), P = .007, and DCD: 1.54 (0.72-3.35), P = .262; Reference: immediate graft function). Early graft dysfunction has a differential impact on graft outcome in DBD and DCD. The differences between DBD and DCD should be accounted for in research and the clinic.

Keywords: acute kidney injury; death-censored graft loss; deceased-donor kidney transplantation; delayed graft function; donation after brain death; donation after circulatory death; slow graft function.