Recipient and allograft survival following donation after circulatory death versus donation after brain death for renal transplantation: A systematic review and meta-analysis.Gavriilidis, P. and N. G. Inston.
Transplantation Reviews 2020 [record in progress].
The aim of this study was to determine the short-term and long-term outcomes of donation after circulatory death (DCD) compared to donation after brain death (DBD) renal transplantation.
Databases including MEDLINE (PubMed), Google Scholar, Cochrane library and Embase were searched for articles published in the last 20 years. Data was extracted by two independent reviewers. The quality of the included studies were assessed using the Newcastle-Ottawa scale (NOS).
12 studies were included in the review.
The primary outcomes were patient and graft survival rates at 1, 3, 5 and 10 years of follow-up.
This systematic review and meta-analysis investigated the differences in long-term outcomes between DBD and DCD renal transplants. The authors identified 12 studies comparing DCD and DBD outcomes and concluded that graft and patient survival are similar out to 10 years post-transplant. The DCD cohort appeared to have a lower rate of acute rejection than the DBD cohort. There are some inherent issues with the use of retrospective data of this nature. Whilst the authors used hazard ratios where possible for survival outcomes, it is not clear which of the included studies had corrected for potential confounders in the original analysis. As noted in the paper, DCD donors are often younger, with a shorter CIT, and in many programs are given more intensive immunosuppression as early rejection may be masked by ongoing DGF. These factors may affect rejection rates and longer-term outcomes, and so it is not possible to fully determine the effect of DBD vs. DCD donation in isolation. Most analyses included only 3 or 4 studies, often with one large registry study dominating. It is not clear whether uncontrolled DCD donors are included. Nonetheless, this is a good attempt at dissecting a challenging topic and does provide some support for the development of DCD programs.