Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis

Donation after circulatory death (DCD) kidney transplantation has been introduced to address organ shortage. However, DCD kidneys are not accepted worldwide due concerns about inferior quality. To investigate whether these justified, we performed a systematic review and meta-analysis graft outcomes compared donation brain (DBD). EMBASE, Medline, Cochrane, Web of Science Google Scholar were searched from database inception until September 2020. Exclusion criteria studies reporting on pediatric/dual transplants, multi-organ transplants or including normothermic perfusion techniques. The primary outcome was survival. Secondary non-function (PNF), delayed function (DGF), 3-months biopsy-proven acute rejection (BPAR), 1-year estimated Glomerular Filtration Rate (eGFR), patient survival, urologic complications. A random-effects model used for meta-analysis. Meta-regression analysis in case high between-study heterogeneity. Fifty-one included, comprising 73,454 518,229 DBD recipients. One-year loss increased recipients (death-censored: risk ratio (RR) 1.10 (95%-confidence interval (CI) 1.04–1.16), all-cause: RR 1.13 (95%-CI 1.08–1.19)). Ten-year similar 1.02 0.92–1.13), 1.03 0.94–1.13)). had an PNF (RR 1.43 1.26–1.62)), DGF 2.02 1.88–2.16)), mortality 1.01–1.21)). No differences observed BPAR, ureter stenosis/leakage, eGFR 10-year mortality. Long-term transplant despite higher PNF, DGF, 13% the first year transplantation. These results should encourage implementation programs.