198 The impact of donation after circulatory death (DCD) donation on kidney allograft survival is influenced by donor race: An UNOS registry analysis

Abstract Background Large scale registry studies have demonstrated that donation after circulatory death (DCD) and donation after brain death (DBD) donor kidney transplants have comparable graft survival. However, donor race, a known risk for graft survival, has not been considered in these analyses. Additionally, there is growing evidence to suggest potential racial differences in renal ischaemic tolerance. This study aims to address this knowledge gap, evaluating whether donor race modifies the impact of DCD donation on graft survival using a large, multi-centre database. Methods A retrospective observational analysis was performed using 261,634 kidney transplant recipients from the UNOS/OPTN database (1987 - 2020), stratified by donor race. Risk-adjusted outcomes were assessed by multivariate cox analysis and visualized using Kaplan-Meier survival curves. Results Donor race significantly modified the effect of DCD donation on graft survival. Black donor DCD recipients experienced improved graft survival at 5 (HR 0.89, 95% CI 0.8-1.0, p < 0.05), 10 (HR 0.9, 95% CI 0.82-0.99, p < 0.05) and 15 years (HR 0.92, 95% CI 0.84-1.0, p < 0.05) compared to DBD. White donor DCD recipients experienced worse graft survival at 15 years (HR 1.08, 95% CI 1.04-1.11, p < 0.001), with no differences at 5 and 10 years. Conclusion DCD donation was associated with improved long-term graft survival compared to DBD in recipients of kidneys from Black donors, while recipients of DCD kidneys from White donors experienced reduced long-term graft survival compared to DBD. This highlights a potential role of donor race in modifying the effects of DCD donation on graft survival.