Survival Benefits of Kidneys
from Donors after Cardiac Death
Reference: Snoeijs MG, Schaubel DE, Hene
R, et al. Kidneys from donors after cardiac
death provide survival benefi t. J Am Soc
• Due to the increasing incidences of end-stage renal failure in
general, the list of patients waiting for kidney transplantation has
• While the number of recipients have been increasing, the number
of donors have been on the decline.
• This is largely due to the fact of waiting for a kidney from a brain-
dead donor which has been the ideal solution for decades.
• Kidney transplantation has been proven to increase survival
benefits in many developed countries.
• Due to this factor alone, efforts have been ongoing to increase the
number of donor kidneys available for transplantation.
• One way of overcoming the problem of waiting for a kidney from a
brain-dead donor, has been the option of using kidneys from donors
after cardiac death.
• Kidneys from brain-dead donors have been used successfully in
• The graft rejection episodes have been managed with the use of
novel pharmacological agents.
• Kidneys in such cases have been well-preserved and the
transplantation has been carried out after good planning.
• But in case of kidneys from donors after cardiac death, preservation
of the perfusion of the organs has been a challenge.
• This results in acute ischemic injury leading to incidences of delayed
graft rejection or dysfunction of the transplanted kidneys.
• However, transplantation of functioning kidneys has shown
promising results in this category.
• However, there was no data on the benefits of
receiving a kidney from a donor after cardiac death in
comparison with waiting for a kidney from a brain-
dead donor while continuing with routine dialysis.
• A study was conducted by Snoeijs et al. on the survival
benefits of transplanted kidneys received from
different types of donors in the patients on dialysis.
• The patients were registered on the waiting list for
their fi rst kidney transplantation between the years
1999 and 2004.
• At the start of the study, 2708 subjects were recruited and among
them, 133 were excluded because they were not on dialysis or
receiving kidney transplantation from non- Eurotransplant region or
due to being on a multiorgan transplant waiting list.
• The endpoint of the study was considered to be death or end-of-
study on 31/12/2005.
• About 2575 patients completed the study. Among them, 680
received kidneys from brain-dead donors and 459 received kidneys
form donors after cardiac death.
• The authors compared the mortality rates of the patients with
donation after brain death and donation after cardiac death with
that of alternative therapeutic option of dialysis treatment or
waiting on dialysis.
Effects of Kidney Transplantation on Survival
of Dialysis Patients on the Waiting List
• Mortality rate after standard-criteria brain-dead donor
kidney transplantation was 49% lower when compared
with dialysis treatment (hazard ratio (HR) 0.51; 95% confi
dence interval (CI) 0.32–0.81; p=0.004).
• Mortality rate after standard-criteria cardiac-dead donor
kidney transplantation was 56% lower when compared
with continuing dialysis and waiting for a standardcriteria
brain-dead donor kidney (HR 0.44; 95% CI 0.24–0.80;
• Mortality rates after expanded-criteria donors, either from
brain dead donors or cardiac dead donors kidney
transplantation were not signifi cantly different from
conventional therapy (p=0.62 and p=0.15, respectively).
Posttransplant Survival Benefits of
• In transplantation studies, there is a need to study the
mortality rates to assess the success of the transplantation
• The mortality rates change with time after transplantation.
– In the early posttransplantation period, the mortality rate of
transplanted patients was higher than those on conventional
– The mortality rate decreased with the passage of time and led
to a survival benefi t for the transplanted patients in comparison
to the patients on conventional therapy.
• The mortality rate of patients receiving a standardcriteria
kidney from a cardiac-dead donor was equal to patients
receiving conventional therapy at 7 months while the
survival benefi t of the two groups equaled at 13 months.
• After this period, there was an increase in the survival
benefi t for patients receiving the cardiac-dead donor
transplantation in comparison to patients on conventional
therapy on dialysis waiting for a standardcriteria kidney
from a brain-dead donor (see Fig. 1).
• At about 4 years posttransplantation, patients receiving the
cardiac-dead donor transplantation were expected to live
on an average 2.4 months longer than patients on dialysis.
• The same details when assessed in patients after
standardcriteria brain-dead donor kidney transplantation,
mortality rates and survival probabilities were equal to
those of dialysis treatment at 5 and 9 month after
transplantation, respectively, whereupon transplant
recipients had the advantage (see Fig. 2).
• The results are promising towards transplantation of
kidneys from cardiac-dead donors.
• This will help in overcoming the shortage of kidneys for
transplantation in patients with end-stage renal disease.
• Patients who receive standard-criteria cardiac dead donor
kidney transplantation live longer than patients who
continue dialysis treatment with the option of later
receiving conventional brain dead donor kidney
• Longer follow-up will yield more credible data to make the
decision of using kidneys from cardiac-dead patients more
relevant by reducing the waiting times for transplantation.