Introduction: Donation after cardiac death (DCD) is becoming an increasingly common strategy in transplantation and opens the possible donor pool. However, numerous paediatric centres in the UK and several countries in Europe are reluctant to offer DCD kidneys to paediatric recipients. There is only limited data on DCD transplants in the paediatric population. We reviewed the long-term outcomes of paediatric kidney transplants from DCD donors, and compared these to the outcomes of transplants from DBD donors over a 33-year period in the USA.
Methods: Data were retrieved and analysed on kidney transplants from deceased donors in paediatric recipients in 1987-2020 from the United Network for Organ Sharing. Data was compared between paediatric recipients receiving kidney transplants from DBD donors and DCD donors. Data were compared using chi-squared test, t-tests and Kaplan-Meier survival analysis.
Results: Overall, there were 13,127 paediatric kidney transplants from deceased donors, of which 354 were from DCD donors. Patients with transplants from DCD donors were significantly more likely to have delayed allograft function than from DBD donors (20.1% vs 11.9%, p<0.01) however there was no significant difference in the rates of primary non-function (1.1% vs 1.2%, p=0.81). When controlling for era effect, there was no significant difference in graft or patient survival between transplants from DBD and DCD donors (56% vs 55%, p=0.76 and 90% vs 91%, p=0.89, respectively).
Discussion: We describe the largest cohort of paediatric DCD kidney transplant recipients in the literature. Our data shows that although there are higher rates of delayed allograft function in DCD transplants, the long-term outcomes are equivocal to each other. This shows that kidney transplants from DCD donors are a viable option for children requiring deceased donor kidney transplantation. DCD kidneys should be offered to children equivocally to DBD kidneys as their long-term outcomes do not differ.