Simultaneous Heart and Kidney Transplantation Using Circulatory Death Donors: Are Kidney Graft Outcomes Comparable With Brain Death Donors?

Authors

• Sooyun Caroline Tavolacci, Westchester Medical Center
• Kenji Okumura, New York Medical College
• Ameesh Isath, Brigham and Women's Hospital
• Gabriel B. Rodriguez, Westchester Medical Center
• Corazon De La Pena, Westchester Medical Center
• Junichi Shimamura, Westchester Medical Center
• Ryosuke Misawa, New York Medical College
• Steven L. Lansman, Westchester Medical Center
• Suguru Ohira, Westchester Medical Center

DOI

10.1097/TXD.0000000000001853

Journal Title

Transplantation Direct

Document Type

Article

Publication Date

10-1-2025

Department

Surgery

Disciplines

Medicine and Health Sciences

Abstract

Background. – There is limited evidence on heart and kidney transplants using donation after circulatory death (DCD) donors, especially regarding graft outcomes. However, little is known about the use of DCD donors for simultaneous heart and kidney transplants (SHKTs) compared with SHKTs using donation after brain death (DBD) donors. Methods. – From May 22, 2020, to September 30, 2023, 1129 adult patients received SHKTs (DCD, N = 91 versus DBD, N = 1038), identified using the United Network for Organ Sharing database, excluding other multiorgan transplants and retransplants. A propensity score matching was performed using characteristics. Ninety-one DCD- and 273 DBD-matched cases were compared. Results. – In the unmatched cohort, DCD recipients were older (DCD: 60 versus DBD: 58 y, P = 0.03), had a lower rate of dialysis at transplant (27% versus 40%, P = 0.03), and were of status 1 to 2 (43% versus 72%, P < 0.001). In the matched cohort, kidney delayed graft function (27% versus 22%, P = 0.29) was comparable, as were recipient survival (P = 0.19), heart graft survival (P = 0.19), and kidney graft survival (P = 0.17). In multivariate Cox proportional hazards analysis, donor type (DCD) was not associated with an increased risk of mortality (hazard ratio, 1.69; 95% confidence interval, 0.90-3.16; P = 0.10). Subgroup analysis showed that survival and freedom from graft failures were comparable between different modes of DCD recovery. Conclusions. – SHKT using DCD donors yields comparable survival and graft outcomes to those using DBD donors. These findings may help donor selection in heart transplant candidates with kidney dysfunction.

Recommended Citation

Tavolacci, S., Okumura, K., Isath, A., Rodriguez, G., De La Pena, C., Shimamura, J., Misawa, R., Lansman, S., & Ohira, S. (2025). Simultaneous Heart and Kidney Transplantation Using Circulatory Death Donors: Are Kidney Graft Outcomes Comparable With Brain Death Donors?. Transplantation Direct, 11 (10). https://doi.org/10.1097/TXD.0000000000001853