Comparison And Multiple-factor Analysis In Early Outcome Of Donor After Cardiac Death And Living Donor Kidney Transplantation

Objectives.The aim was to compare the early outcome between the donor after cardiac death and living donor kidney transplantation and investigate the factors that affected the early outcome of these two types of transplantation.Methods.This retrospective study included 332 patients and 416 patients who accepted first renal transplantation of donor after cardiac death (DCD) and living donor (LD) respectively at the Kidney Disease Center, First Affiliated Hospital, Medical College of Zhejiang University from Oct 8,2010 to Dec 31,2014. We compared the estimated glomerular filtration (eGFR) of LD recipients and DCD recipients at different time points within 1 year post-transplantation. The incidence rate of delayed graft function (DGF) and acute rejection (AR) in the two different groups was compared. Similarly, comparison of the graft and patient survival between the two groups was performed. We used multiple-factor analysis to investigate the factors that affected overall graft survival within 1 year post-transplantation and incidence of DGF in DCD recipients. The linear regression analysis was respectively performed in DCD recipients and LD recipients to find the factors associated with 1-year eGFR.Results.The eGFR level of LD recipients at the time point of 1-day,7-day,14-day and 1-month post-transplantation were significantly higher than that of DCD recipients, however, it tended to equalize after 2 month post-transplantation. There was a significant difference of DGF incidence rate between LD and DCD recipients, nonetheless, the incidence rate of AR were similar in these two groups.1-year graft survival rate,1-year patient survival rate and 1-year death-censored graft survival rate were lower in DCD recipients compared with LD recipients. We took 2-month post-transplantation as a divide-point to separate the 1 year fellow-up duration into two parts, then compared the graft survival rate of DCD recipients with that of LD recipients in the two separated fellow-up period. We found that the graft survival rate of LD recipients was higher than that of DCD recipients in the first fellow-up period (0-day to 2-month), interestingly, no significant difference was found in the second period (2-month to 1-year). As multiple-factor analysis demonstrated, incidence of DGF was an independent risk factor of 1-year graft loss among DCD recipients. Decreasing donor/recipient body surface area ratio (D/R BSA) and increasing terminal serum creatinine concentration were found as independent risk factors for incidence of DGF in DCD recipients. Age of donor, gender of donor, death cause of donor and D/R BSA were independent predictors for 1-year graft function in DCD recipients. Correspondingly, age of donor, terminal serum creatinine concentration, age of recipient, incidence of AR or not in recipients and D/R BSA were independent predictors for 1-year graft function in LD recipients.Conclusion.The 2-month graft survival and graft function of DCD recipients were lower than that of LD recipients. The DCD recipients who survived over 2 month had a similar early outcome with LD recipients regardless of graft survival rate and graft function. DCD recipients who suffered DGF should be intensively monitored since they had a higher graft loss rate than others within 1 year after transplantation. Clinicians should pay more attention on the age, gender, terminal serum creatinine concentration when evaluating a potential donor, in addition, the death cause of patient should be taken into consideration when it is a DCD potential donor. Furthermore, the bodily form of donor and recipient should be considered when deciding which patient should accept transplantation to optimize donor and recipient matching.