ImportanceIn the Netherlands, organ donation after euthanasia (donation after circulatory death type V [DCD-V]) has been increasingly performed since 2012. However, the outcomes of DCD-V kidney grafts have not been thoroughly investigated. It is critical to assess the outcomes of these kidney grafts to ascertain whether DCD-V is a safe and valuable way to increase the kidney donor pool.ObjectivesTo investigate the outcomes of DCD-V kidney transplantation and compare them with outcomes of kidney transplantation after circulatory death after withdrawal of life-sustaining therapies (DCD type III [DCD-III]) and donation after brain death (DBD).Design, Setting, and ParticipantsA retrospective cohort study was conducted using the database from the Dutch Transplant Foundation. All kidney transplants in the Netherlands between January 2012 (start of the euthanasia program) and July 2023 were included. Follow-up was obtained through 5 years after transplantation. Data analysis was performed from November 2023 until February 2024.ExposuresKidney transplantation with a DCD-V graft compared with DCD-III and DBD grafts.Main Outcomes and MeasuresThe primary outcome was death-censored graft survival until 5 years after transplantation. Secondary outcomes were the incidence of delayed graft function (DGF), permanent nonfunction (PNF), serum creatinine concentration, and patient survival until 5 years after kidney transplantation.ResultsA total of 145 DCD-V kidney transplants were compared with 1936 DCD-III and 1255 DBD kidney transplants. Median (IQR) recipient age was 59 (46-66) years in the DCD-V cohort, compared with 61 (50-68) years in the DCD-III cohort and 61 (50-68) years in the DBD cohort. The incidence of DGF with DCD-V kidney transplants (26%) was significantly less than that with DCD-III kidney transplants (49%; P < .001) and similar to that with DBD kidney transplants (22%; P = .46). PNF occurrence with DCD-V kidneys (6%) was similar to that with DCD-III kidneys (6%; P = .79) and higher than in DBD kidneys (4%; P < .001). There was no difference in 5-year death-censored graft survival between DCD-V grafts (82%) and DCD-III (86%; P = .99) or DBD (84%; P = .99) grafts. There was no difference in 5-year patient survival between DCD-V kidney transplants (69%) and DCD-III (76%; P = .45) or DBD (73%; P = .74) kidney transplants. A propensity score analysis was performed to match the DCD-V and DCD-III cohort, showing results similar to those of the unmatched cohort.Conclusions and RelevanceThis study found that DCD-V kidney transplantation yielded a lower incidence of DGF compared with DCD-III kidney transplantation and yielded long-term results similar to those of DCD-III and DBD kidney transplantation. The findings suggest that DCD-V is a safe and valuable way to increase the kidney donor pool.

中文翻译：

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安乐死后捐献后的肾移植结果


重要性在荷兰，自 2012 年以来，安乐死后的器官捐献（循环死亡 V 型 [DCD-V] 后捐献）的实施越来越多。然而，DCD-V 肾移植物的结果尚未得到彻底的研究。评估这些肾移植物的结果以确定 DCD-V 是否是增加肾脏供体库的安全且有价值的方法至关重要。目的探讨 DCD-V 肾移植的结局，并将其与停止维持生命治疗后循环死亡 （DCD III 型 [DCD III] ] 和脑死亡后捐献 （DBD） 的结局进行比较。设计、环境和参与者使用荷兰移植基金会的数据库进行了一项回顾性队列研究。包括 2012 年 1 月（安乐死计划开始）至 2023 年 7 月期间荷兰的所有肾移植。移植后 5 年进行随访。数据分析于 2023 年 11 月至 2024 年 2 月进行。主要结局和测量主要结局是移植后 5 年内死亡删失的移植物存活率。次要结局是延迟移植物功能 （DGF） 、永久无功能 （PNF） 、血清肌酐浓度和肾移植后 5 年患者生存率。结果共 145 例 DCD-V 肾移植与 1936 例 DCD-III 和 1255 例 DBD 肾移植进行了比较。DCD-V 队列的中位 （IQR） 接受者年龄为 59 （46-66） 岁，而 DCD-III 队列为 61 （50-68） 岁，DBD 队列为 61 （50-68） 岁。 DCD-V 肾移植的 DGF 发生率 （26%） 显著低于 DCD-III 肾移植 （49%;P < .001），与 DBD 肾移植相似 （22%;P = .46）。DCD-V 肾脏的 PNF 发生率 （6%） 与 DCD-III 肾脏的 PNF 发生率 （6%;P = .79） 并高于 DBD 肾脏 （4%;P < .001）。DCD-V 移植物 （82%） 和 DCD-III （86%） 之间的 5 年死亡删失移植物存活率没有差异;P = .99） 或 DBD （84%;P = .99） 移植物。DCD-V 肾移植 （69%） 和 DCD-III （76%） 之间的 5 年患者生存率没有差异;P = .45） 或 DBD （73%;P = .74） 肾移植。进行倾向评分分析以匹配 DCD-V 和 DCD-III 队列，显示结果与不匹配队列的结果相似。结论和相关性本研究发现，与 DCD-III 肾移植相比，DCD-V 肾移植产生的 DGF 发生率较低，并且产生的长期结果与 DCD-III 和 DBD 肾移植相似。研究结果表明，DCD-V 是增加肾脏供体库的一种安全且有价值的方法。