Antecedent Cardiac Arrest Status of Donation After Circulatory Determination of Death (DCDD) Kidney Donors and the Risk of Delayed Graft Function After Kidney Transplantation: A Cohort Study

Adam Philipoff; Yingxin Lin; Armando Teixeira-Pinto; Ryan Gately; Jonathan C Craig; Helen Opdam; Jeremy C Chapman; Henry Pleass; Natasha M Rogers; Christopher E Davies; Stephen McDonald; Jean Yang; Pedro Lopez; Germaine Wong; Wai H Lim

doi:10.1097/TP.0000000000005022

Antecedent Cardiac Arrest Status of Donation After Circulatory Determination of Death (DCDD) Kidney Donors and the Risk of Delayed Graft Function After Kidney Transplantation: A Cohort Study

Transplantation. 2024 Apr 30. doi: 10.1097/TP.0000000000005022. Online ahead of print.

Authors

Adam Philipoff¹, Yingxin Lin^{2

3}, Armando Teixeira-Pinto^{2

4}, Ryan Gately⁵, Jonathan C Craig^{4

6}, Helen Opdam^{7

8}, Jeremy C Chapman⁹, Henry Pleass¹⁰, Natasha M Rogers^{9

11}, Christopher E Davies^{12

13}, Stephen McDonald^{12

13

14}, Jean Yang³, Pedro Lopez^{15

16

17}, Germaine Wong^{2

4

11}, Wai H Lim^{15

18}

Affiliations

¹ Department of Transplant Surgery, Western Australian Kidney and Liver Transplant Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.
² Public Health, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
³ Sydney Precision Data Science, Faculty of Science, School of Mathematics and Science, University of Sydney, Sydney, NSW, Australia.
⁴ Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, NSW, Australia.
⁵ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
⁶ College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
⁷ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
⁸ DonateLife, Organ and Tissue Authority, Canberra, ACT, Australia.
⁹ The Westmead Institute for Medical Research, Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.
¹⁰ Specialty of Surgery, University of Sydney, Sydney, NSW, Australia.
¹¹ Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia.
¹² Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
¹³ Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
¹⁴ Department of Renal Medicine, Central Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.
¹⁵ Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.
¹⁶ Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.
¹⁷ Grupo de Pesquisa em Exercício para Populações Clínicas (GPCLIN), Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil.
¹⁸ Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.

PMID: 38685196
DOI: 10.1097/TP.0000000000005022

Abstract

Background: The number of donors from donation after circulatory determination of death (DCDD) has increased by at least 4-fold over the past decade. This study evaluated the association between the antecedent cardiac arrest status of controlled DCDD donors and the risk of delayed graft function (DGF).

Methods: Using data from the Australia and New Zealand Dialysis and Transplant, the associations between antecedent cardiac arrest status of DCDD donors before withdrawal of cardiorespiratory support, DGF, posttransplant estimated glomerular filtration rate (eGFR), and allograft loss were examined using adjusted logistic, linear mixed modeling, and cox regression, respectively. Among donors who experienced cardiac arrest, we evaluated the association between duration and unwitnessed status of arrest and DGF.

Results: A total of 1173 kidney transplant recipients received DCDD kidneys from 646 donors in Australia between 2014 and 2019. Of these, 335 DCDD had antecedent cardiac arrest. Compared with recipients of kidneys from donors without antecedent cardiac arrest, the adjusted odds ratio (95% confidence interval) for DGF was 0.85 (0.65-1.11) among those with kidneys from donors with cardiac arrest. There was no association between antecedent cardiac arrest and posttransplant eGFR or allograft loss. The duration of cardiac arrest and unwitnessed status were not associated with DGF.

Conclusions: This focused analysis in an Australian population showed that the allograft outcomes were similar whether DCDD donors had experienced a prior cardiac arrest, with no associations between duration or unwitnessed status of arrest and risk of DGF. This study thus provides important reassurance to transplant programs and the patients they counsel, to accept kidneys from donors through the DCDD pathway irrespective of a prior cardiac arrest.