Factors Influencing Renal Allograft Loss From Donation After Citizens’ Death

IntroductionTo meet the urgent need for transplantable organs,a donation after citizens’ death program was initiated by China’s government in 2010 and developed rapidly in recent years.Donation after citizens’ death program includes three categories in Chinese guidelines of kidney transplantation: donation after cardiac death(DCD),donation after brain death(DBD),and donation after brain death followed by circulatory death(DBCD).Especially DBCD,a new process with Chinese characteristics from the standard,well balanced the contradiction between the protection of organ functions and acceptability of brain death,which is not well accepted by Chinese traditional concepts and current laws.The purpose of this study was to evaluate the prognosis and complications of renal transplantation in our center under this new policy.In addition,the risk factors that may affect the survival of transplanted kidney were verified according to the data of ours,which may be a reference for the improvement of organ procurement and allocation criteria under this new policy.MethodA retrospective study involving 421 kidney transplant cases derived from 214 donors were completed by the process of donation after citizens’ death from December 2011 to October 2019 at our center.Baseline characteristics between each groups were compared using Student’s t test,Chi-square test,and Mann-Whitney U test.Kaplan-Meier method was used to compare the death‐censored graft survival between the two groups and occurrence of AR,infection,and draw the survival curve.Statistical differences between curves were assessed using the log-rank test.Differences in the occurrence of DGF between the two groups were identified using the Chi-square test.The identification of risk factors for graft failure was based on Cox proportional hazard model.ResultThe 1-,3-,5-year overall graft survival rates were 90.1%,88.4%,and 86.0%.DBCD group showed better than DCD group in allograft survival by comparing the graft survival curve using the log-rank test(p=0.017).However,there was no significant differences in post-operative complications between the two groups.Cox regression analysis revealed that increasing donors(p=0.002,HR=1.820/10-year increase)and recipients(p=0.028,HR=1.521/10-year increase)age,prolonged dialysis duration(p=0.007,HR=1.018),the occurrence of acute rejection(p=0.016,HR=2.697)and delayed graft function(p=0.012,HR=2.962),HLA mismatch≥4 loci(p=0.038,HR=3.606),warm ischemia time>15min(p=0.022,HR=2.915)were independent risk factors may affect graft survival.ConclusionResults indicated satisfying outcomes of renal transplantation from donation after citizens’ death.The overall prognosis of kidney transplantation is comparable to that of the international mature transplantation system.The prognosis of DBCD was better than that of DCD.The main risk factors for allograft loss are increasing donors’ and recipients’ age,warm ischemia time>15min,and recipients with hypertension,prolonged dialysis duration,acute rejection and delayed graft function occurrence,HLA mismatch ≥4 loci.