Cardiopulmonary resuscitation in donation after brain death donors aged ≥65 years: impact on outcomes after kidney transplantation – a multi-center study

A history of cardiopulmonary resuscitation (CPR) is common in donation after brain death (DBD) donors. While good outcomes have been demonstrated for kidney transplantation (KT) from younger CPR donors (aged typically 18–50 years), it is unclear whether this is true for the growing cohort of ≥65-year-old KT donors. To this end, all KTs from ≥65-year-old DBD donors performed at three German transplant centers from January 2006 to December 2023 (n = 680) were retrospectively analyzed and outcomes of KTs from donors with and without a history of CPR were compared (n = 81 and n = 599, respectively). No significant differences were observed regarding the incidence of delayed graft function (DGF) as well as regarding 1- and 5-year graft function between the CPR and no-CPR groups (DGF: 27.2% vs. 33.1%, p = 0.40; 1-year eGFR (mL/min): 33.3 vs. 35.0, p = 0.75; 5-year eGFR: 35.8 vs. 37.3, p = 0.75, respectively). Death-censored graft survival (73.8% vs. 66.0%, p = 0.24) and patient survival (78.7% vs. 73.5% p = 0.61) were comparable after 5 years between the CPR and no-CPR groups. The results were confirmed by multivariable Cox regression analysis. In conclusion, our results indicate that ≥65-year-old DBD donors with a history of CPR are potentially suitable for KT without impairing allograft outcomes.