Delayed Graft Function Equally Worsens Early Outcomes in Kidney Recipients from Donation after Circulatory Death vs. Brain Death Donors

Background: While delayed graft function (DGF) is more common after donation after circulatory death (DCD) vs donation after brain death (DBD) kidney transplantation, we sought to determine if risk factors for DGF and post-transplant outcomes differ across donor type. Methods: We studied all adult kidney deceased donor recipients (DDKTR) transplanted between 2005-2019 at UW Health Transplant Center, stratified by donor type (DBD vs. DCD). DGF was defined as dialysis within the first week after transplantation. Outcomes of interest included DGF, acute rejection (AR), one-year uncensored (GF) and death-censored graft failure (DCGF). Results: Among 2543 DDKTs, 804 (31%) were DCD. In DBD recipients, older donor age, higher terminal creatinine, higher KDPI, right kidney, prolonged cold ischemia time (CIT), higher recipient BMI, and depleting induction agent were associated with higher risk for DGF, while female recipient and preemptive transplant were protective. Similarly, among DCD, older donor age, female donor, higher donor and recipient BMI, and depleting induction were associated with increased risk, while female recipient and preemptive transplant were protective. While DGF was significantly associated with higher risk for AR and GF, these associations did not differ significantly between DBD and DCD in adjusted models: AR (HR: 2.22 in DBD vs 2.37 in DCD; p-interaction=0.65); GF (3.04 vs 2.56; p-interaction=0.47). There were no adjusted DCGF to compare. Conclusion: Several factors differ between DBD and DCD for risk of DGF. However, early outcomes were similarly worsened in both groups.