Kidney Transplant Outcomes From Deceased Donors Who Received Dialysis.
Kidneys recovered from deceased donors who had been on dialysis before donation were much more likely to be slow to start working, but at nearly three years of follow-up they failed no more often than other kidneys and recipients did not die more often. Four in ten such kidneys are currently discarded.
Background
Recipient outcomes after kidney transplant from deceased donors who received dialysis prior to donation are not well described, and a large share of these organs are declined. The study set out to compare them against kidneys from donors who did not undergo dialysis.
Study design
A retrospective cohort study used data from 58 US organ procurement organizations. From 2010 to 2018, 805 donors who underwent dialysis prior to kidney donation were identified and matched 1:1 with donors who did not, using a rank-based distance matrix algorithm; 1944 kidney transplant recipients were evaluated. Outcomes were delayed graft function, all-cause graft failure, death-censored graft failure, and death.
Key findings
Only 1.4% of deceased kidney donors (805 of 58 155) underwent dialysis prior to donation; of these, 969 kidneys (60%) were transplanted and 641 (40%) were discarded. Delayed graft function occurred in 59.2% versus 24.6% (adjusted odds ratio 4.17, 95% CI 3.28-5.29). At a median follow-up of 34.1 months there was no significant difference in all-cause graft failure (adjusted HR 0.90, 95% CI 0.70-1.15), death-censored graft failure (adjusted HR 1.18, 95% CI 0.83-1.69) or death (adjusted HR 0.76, 95% CI 0.55-1.04).
Clinical implications
The findings suggest that donor pre-donation dialysis predicts a difficult early post-transplant course rather than inferior medium-term graft survival, which is directly relevant to the high discard rate observed for these organs.
Category
Transplant
Source
JAMA
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