Abstract Journal Transplantation Surgery

Purpose: Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys.This systematic review investigated uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD).Methodology: MEDLINE, Cochrane and Embase databases were searched.Data on demographic information and transplant outcomes were extracted from included studies.Meta-analyses were performed, and risk ratios (RR) were estimated to compare transplant outcomes from uDCD to cDCD.Results: Nine cohort studies were included, from 2178 uDCD kidney transplants.There was a moderate degree of bias, as four studies did not account for potential confounding factors.The median incidence of primary nonfunction (PNF) in uDCD was 12.3%, versus 5.7% for cDCD (RR: 1.85; 95% CI 1.06-3.23;P = 0.03, I 2 = 75).The median rate of delayed graft function (DGF) was 65.1% for uDCD and 52.0% for cDCD (RR: 1.27; 95% CI 1.09-1.48;P = 0.002; I 2 = 74%).The median 1-year graft survival for uDCD was 82.7% compared to 87.5% for cDCD (RR: 1.43.; 95% CI 1.02-2.01;P = 0.04, I 2 = 71%).The median 5-year graft survival for uDCD and cDCD was 70% each.Notably, the use of normothermic regional perfusion (NRP) improved PNF rates in uDCD grafts. Conclusion:In conclusion, if uDCD grafts survive beyond the first year, longer term outcomes are comparable to cDCD, which may be facilitated by technologies such as NRP.Therefore, uDCD kidneys could be used to expand the donor pool within Australia and New Zealand.