Local Expansion of Donation After Circulatory Death Kidney Transplant Activity Improves Waitlisted Outcomes and Addresses Inequities of Access to Transplantation.

In the UK, circulatory death (DCD) kidney transplant activity has increased rapidly, but marked regional variation persists. We report how increased DCD kidney transplant activity influenced wait-listed outcomes for a single centre. Between 2002/03 and 2011/12, 430 (54%) DCD and 361 (46%) DBD kidney-only transplants were performed in the Cambridge Transplant Centre, with a higher proportion of DCD donors fulfilling expanded criteria status (41% DCD vs 32% DBD; P=0.01). Compared to UK outcomes, where the proportion of DCD:DBD kidney transplants performed is lower (25%; P 65 years) patients (waiting time 730 vs 1357 days nationally; P<0.001), who received predominantly DCD kidneys from old donors (mean donor age 64), whereas younger recipients received equal proportions of living-donor, DBD and DCD kidney transplants. Death-censored kidney graft survival was nevertheless comparable for young and elderly recipients, although transplantation conferred a survival benefit from listing for only younger recipients. Local expansion in DCD kidney transplant activity therefore improves survival outcomes for younger patients and addresses inequity of access to transplantation for elderly recipients. This article is protected by copyright. All rights reserved.