Time to Death and Donation After Circulatory Death Kidney Transplant Outcomes: Opportunities for Improved Utilization in the United States
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Wiley
2026
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| author | Dharesh Raj Amarnath Tanissha Sanjay Raj Kalpana Georgios Kourounis Abdullah K. Malik Jennifer Philip Emily R. Thompson Emily Glover Gavin J. Pettigrew Chris Callaghan Neil Sheerin Colin Wilson Samuel J. Tingle |
| author_facet | Dharesh Raj Amarnath Tanissha Sanjay Raj Kalpana Georgios Kourounis Abdullah K. Malik Jennifer Philip Emily R. Thompson Emily Glover Gavin J. Pettigrew Chris Callaghan Neil Sheerin Colin Wilson Samuel J. Tingle Dharesh Raj Amarnath Tanissha Sanjay Raj Kalpana Georgios Kourounis Abdullah K. Malik Jennifer Philip Emily R. Thompson Emily Glover Gavin J. Pettigrew Chris Callaghan Neil Sheerin Colin Wilson Samuel J. Tingle |
| collection | Wiley Open Access |
| contents | Time to Death and Donation After Circulatory Death Kidney Transplant Outcomes: Opportunities for Improved Utilization in the United States Dharesh Raj Amarnath Tanissha Sanjay Raj Kalpana Georgios Kourounis Abdullah K. Malik Jennifer Philip Emily R. Thompson Emily Glover Gavin J. Pettigrew Chris Callaghan Neil Sheerin Colin Wilson Samuel J. Tingle Clinical Transplantation ABSTRACT Background Concerns persist that prolonged time to death (TTD) following withdrawal of life‐sustaining treatment may impair organ quality. Although previous European studies have demonstrated that prolonged TTD does not impact post‐transplant kidney graft survival, it remains unclear whether these findings apply to the US donor pool. Methods We used OPTN data on adult DCD single‐kidney transplants (2010–2023). Multiple imputation was used for missing data. Multivariable regression models, with restricted cubic splines for non‐linear modelling, were used to evaluate the impact of donor TTD on kidney transplant outcomes. Results Median donor TTD was 14 min (IQR, 10–21 min). Donor TTD was not associated with recipient graft survival ( p = 0.469), mortality ( p = 0.528) or 1‐year eGFR ( p = 0.393). These findings were consistent regardless of normothermic regional perfusion use (NRP cohort: n = 1227; non‐NRP cohort: n = 35 328), and within the large ex‐situ hypothermic machine perfusion cohort (HMP‐ cohort: n = 22 218). Only 4.1% of transplanted DCD kidneys were from donors with TTD of over 60 min, and just 0.1% exceeded 120 min. Conclusions Increasing donor TTD was not associated with worse post‐kidney‐transplant outcomes within this cohort predominantly comprising donors with TTD 0–60 min. In contrast to this US setting, a previous UK study reported that a higher proportion of transplanted DCD kidneys were from prolonged TTD donors (12.3% from donors TTD >60 min; 4.2% from >120 min). This highlights an opportunity to safely expand the US DCD donor pool, especially in the era of machine perfusion where viability assessment may provide an additional safeguard. 10.1111/ctr.70548 http://creativecommons.org/licenses/by/4.0/ |
| doi_str_mv | 10.1111/ctr.70548 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70548 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by/4.0/ |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Time to Death and Donation After Circulatory Death Kidney Transplant Outcomes: Opportunities for Improved Utilization in the United States Dharesh Raj Amarnath Tanissha Sanjay Raj Kalpana Georgios Kourounis Abdullah K. Malik Jennifer Philip Emily R. Thompson Emily Glover Gavin J. Pettigrew Chris Callaghan Neil Sheerin Colin Wilson Samuel J. Tingle Clinical Transplantation Time to Death and Donation After Circulatory Death Kidney Transplant Outcomes: Opportunities for Improved Utilization in the United States Dharesh Raj Amarnath Tanissha Sanjay Raj Kalpana Georgios Kourounis Abdullah K. Malik Jennifer Philip Emily R. Thompson Emily Glover Gavin J. Pettigrew Chris Callaghan Neil Sheerin Colin Wilson Samuel J. Tingle Clinical Transplantation ABSTRACT Background Concerns persist that prolonged time to death (TTD) following withdrawal of life‐sustaining treatment may impair organ quality. Although previous European studies have demonstrated that prolonged TTD does not impact post‐transplant kidney graft survival, it remains unclear whether these findings apply to the US donor pool. Methods We used OPTN data on adult DCD single‐kidney transplants (2010–2023). Multiple imputation was used for missing data. Multivariable regression models, with restricted cubic splines for non‐linear modelling, were used to evaluate the impact of donor TTD on kidney transplant outcomes. Results Median donor TTD was 14 min (IQR, 10–21 min). Donor TTD was not associated with recipient graft survival ( p = 0.469), mortality ( p = 0.528) or 1‐year eGFR ( p = 0.393). These findings were consistent regardless of normothermic regional perfusion use (NRP cohort: n = 1227; non‐NRP cohort: n = 35 328), and within the large ex‐situ hypothermic machine perfusion cohort (HMP‐ cohort: n = 22 218). Only 4.1% of transplanted DCD kidneys were from donors with TTD of over 60 min, and just 0.1% exceeded 120 min. Conclusions Increasing donor TTD was not associated with worse post‐kidney‐transplant outcomes within this cohort predominantly comprising donors with TTD 0–60 min. In contrast to this US setting, a previous UK study reported that a higher proportion of transplanted DCD kidneys were from prolonged TTD donors (12.3% from donors TTD >60 min; 4.2% from >120 min). This highlights an opportunity to safely expand the US DCD donor pool, especially in the era of machine perfusion where viability assessment may provide an additional safeguard. 10.1111/ctr.70548 http://creativecommons.org/licenses/by/4.0/ |
| title | Time to Death and Donation After Circulatory Death Kidney Transplant Outcomes: Opportunities for Improved Utilization in the United States |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70548 |