New donor selection criteria result in optimal outcomes of kidneys from uncontrolled donation after the circulatory determination of death

Abstract

Background: The aim of our study is to share our experience with uncontrolled donation after the circulatory determination of death (uDCDD) kidney transplantation and to propose updated donor selection criteria for uDCDD programs. Methods: A prospective study comparing kidney recipients of grafts from local uDCDD donors with recipients of grafts from local standard criteria donors after the neurological determination of death (DNDD) between 2013 and 2024. Donor acceptance was determined using a combination of 3 factors: donor age, no-flow period, and warm ischemic time (WIT). Normothermic regional perfusion was the preservation method in uDCDD cases. Results: The study included 43 kidney recipients from uDCDD donors and 80 controls. The median no-flow period was 10 min (interquartile range, 5-13), and the median WIT was 101 min (interquartile range, 86-118). The incidence of delayed graft function was significantly higher in the uDCDD group (46.5% versus 21.3%; P = 0.004), although no significant difference was observed in primary nonfunction rates (2.3% versus 0%; P = 0.35). Long-term outcomes, including serum creatinine levels and estimated glomerular filtration rate at 5 y, were similar in both groups. Graft survival rates at 1 y (95.3% versus 100%) and 5 y (92.1% versus 95%) showed no significant differences between the uDCDD and the DNDD groups. Multivariate analysis revealed that uDCDD kidney recipients did not have a higher risk of graft loss. Conclusions: Kidney transplantation from uDCDD donors is a viable option, yielding outcomes comparable with those from standard DNDD donors. Strict donor selection criteria and efforts to minimize WIT are essential to achieving optimal long-term results.