Improving outcomes for donation after circulatory death kidney transplantation: Science of the times

M.J.C. de Kok; A.F.M. Schaapherder; I.P.J. Alwayn; F.J. Bemelman; J. van de Wetering; A.D. van Zuilen; M.H.L. Christiaans; M.C. Baas; A.S. Nurmohamed; S.P. Berger; E. Bastiaannet; R.J. Ploeg; A.P.J. de Vries; J.H.N. Lindeman

doi:10.1371/journal.pone.0236662

Improving outcomes for donation after circulatory death kidney transplantation: Science of the times

M.J.C. de Kok, A.F.M. Schaapherder, I.P.J. Alwayn, F.J. Bemelman, J. van de Wetering, A.D. van Zuilen, M.H.L. Christiaans, M.C. Baas, A.S. Nurmohamed, S.P. Berger, E. Bastiaannet, R.J. Ploeg, A.P.J. de Vries, J.H.N. Lindeman^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990-2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998-2008 [n = 3,499] and 2008-2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998-2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008-2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects.

Original language	English
Article number	0236662
Number of pages	10
Journal	PLOS ONE
Volume	15
Issue number	7
DOIs	https://doi.org/10.1371/journal.pone.0236662
Publication status	Published - 29 Jul 2020

Keywords

cardiac death
cold ischemia
donor kidneys
risk
uk
COLD ISCHEMIA
UK
RISK
CARDIAC DEATH
DONOR KIDNEYS

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10.1371/journal.pone.0236662Licence: CC BY

Cite this

de Kok, M. J. C., Schaapherder, A. F. M., Alwayn, I. P. J., Bemelman, F. J., van de Wetering, J., van Zuilen, A. D., Christiaans, M. H. L., Baas, M. C., Nurmohamed, A. S., Berger, S. P., Bastiaannet, E., Ploeg, R. J., de Vries, A. P. J., & Lindeman, J. H. N. (2020). Improving outcomes for donation after circulatory death kidney transplantation: Science of the times. PLOS ONE, 15(7), Article 0236662. https://doi.org/10.1371/journal.pone.0236662

@article{5f1eebd598c04635aa8ef772a6004464,

title = "Improving outcomes for donation after circulatory death kidney transplantation: Science of the times",

abstract = "The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990-2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998-2008 [n = 3,499] and 2008-2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998-2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008-2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects.",

keywords = "cardiac death, cold ischemia, donor kidneys, risk, uk, COLD ISCHEMIA, UK, RISK, CARDIAC DEATH, DONOR KIDNEYS",

author = "{de Kok}, M.J.C. and A.F.M. Schaapherder and I.P.J. Alwayn and F.J. Bemelman and {van de Wetering}, J. and {van Zuilen}, A.D. and M.H.L. Christiaans and M.C. Baas and A.S. Nurmohamed and S.P. Berger and E. Bastiaannet and R.J. Ploeg and {de Vries}, A.P.J. and J.H.N. Lindeman",

note = "Publisher Copyright: {\textcopyright} 2020 de Kok et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2020",

month = jul,

day = "29",

doi = "10.1371/journal.pone.0236662",

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de Kok, MJC, Schaapherder, AFM, Alwayn, IPJ, Bemelman, FJ, van de Wetering, J, van Zuilen, AD, Christiaans, MHL, Baas, MC, Nurmohamed, AS, Berger, SP, Bastiaannet, E, Ploeg, RJ, de Vries, APJ & Lindeman, JHN 2020, 'Improving outcomes for donation after circulatory death kidney transplantation: Science of the times', PLOS ONE, vol. 15, no. 7, 0236662. https://doi.org/10.1371/journal.pone.0236662

TY - JOUR

T1 - Improving outcomes for donation after circulatory death kidney transplantation

T2 - Science of the times

AU - de Kok, M.J.C.

AU - Schaapherder, A.F.M.

AU - Alwayn, I.P.J.

AU - Bemelman, F.J.

AU - van de Wetering, J.

AU - van Zuilen, A.D.

AU - Christiaans, M.H.L.

AU - Baas, M.C.

AU - Nurmohamed, A.S.

AU - Berger, S.P.

AU - Bastiaannet, E.

AU - Ploeg, R.J.

AU - de Vries, A.P.J.

AU - Lindeman, J.H.N.

N1 - Publisher Copyright: © 2020 de Kok et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2020/7/29

Y1 - 2020/7/29

N2 - The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990-2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998-2008 [n = 3,499] and 2008-2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998-2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008-2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects.

AB - The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990-2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998-2008 [n = 3,499] and 2008-2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998-2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008-2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects.

KW - cardiac death

KW - cold ischemia

KW - donor kidneys

KW - risk

KW - uk

KW - COLD ISCHEMIA

KW - UK

KW - RISK

KW - CARDIAC DEATH

KW - DONOR KIDNEYS

U2 - 10.1371/journal.pone.0236662

DO - 10.1371/journal.pone.0236662

M3 - Article

C2 - 32726350

SN - 1932-6203

VL - 15

JO - PLOS ONE

JF - PLOS ONE

IS - 7

M1 - 0236662

ER -