Introduction Escalating deaths associated with the opioid crisis has increased availability of transplant organs from donors who died of a drug overdose, yet perception of these organs as "increased risk" contributes to their unnecessary discard. Previous research addressing this issue has focused solely on survival outcomes, but quality of life is also a crucial factor in determining transplant success.Methods In this study, a secondary analysis of data representing adult, first-time heart transplant recipients from the Scientific Registry of Transplant Recipients between January 1, 2016, and March 1, 2020 was conducted. Logistic regression modeled one-year survival and functional status at one-year, and Cox proportional hazards modeled survival time post-transplant. Non-inferiority testing compared survival and functional status outcomes for overdose donor (n = 2240) and non-overdose donor (n = 9427) organ recipients.Results When not controlling for significant covariates, one-year survival rates, post-transplant survival time, and one-year Karnofsky scores were at least as good or better for overdose donor organ recipients compared to non-overdose organ recipients based on a-priori non-inferiority thresholds; estimated OR for one-year survival is 1.0207 (95% CI [0.863, 1.213]), estimated hazards ratio is 0.9425 (95% CI [0.823, 1.079]), and estimated OR for having high one-year functional status is 0.9035 (95% CI [0.769, 1.066]). Controlling for significant covariates, one-year survival (OR 0.9613, 95% CI [0.790, 1.176]) and functional status (OR 1.0181, 95% CI [0.855, 1.218]) remained at least as good or better for overdose donor recipients; survival time was also estimated to be as good or better for overdose organ recipients when controlling for significant covariates (HR 0.9611, 95% CI [0.828, 1.115]), but not to the level of statistical significance based on the non-inferiority threshold.Conclusion Overall, post-transplant survival times, one-year survival rates, and one-year functional status are similar for overdose and non-overdose organ heart transplant recipients. These findings support a broader utilization of the drug overdose donor pool, especially as the demand for heart transplantation increases.
Background: Abdominal normothermic regional perfusion (aNRP) may mitigate ischemic injury in donation after circulatory death (DCD). Specific aNRP-DCD kidney transplant (KTx) outcomes are inadequately defined. Kidney Donor Profile Index (KDPI) assigns equivalent DCD risk components to all DCD kidneys and may not capture procurement-related differences. Methods: We retrospectively analyzed KTx from donors in a single donation service area procured between January 2023-December 2024. DCD-restricted multivariable logistic and Cox models compared aNRP-DCD with super-rapid recovery (SRR)-DCD and evaluated KDPI associations with delayed graft function (DGF) and 1-year overall graft survival. Results: 523 KTx (310 from brain-dead donors (BDD), 122 from SRR-DCD, 91 from aNRP-DCD). aNRP-DCD kidneys came from older, higher-KDPI donors than SRR-DCD and BDD (Age 55 vs 43.5 vs 38 years; p = 0.01, p < 0.001; KDPI 66% vs 53% vs 27%; p = 0.008, p < 0.001). In DCD-restricted multivariable analysis, aNRP was associated with lower DGF odds than SRR (OR 0.445, 95% CI 0.23-0.861; p = 0.016). KDPI was associated with DGF (OR 1.028, 95% CI 1.014-1.042; p < 0.001). One-year overall graft survival was similar. KDPI interaction modeling suggested lower DGF odds at comparable KDPI values, however the KDPI & times; donor-type interaction was not statistically significant. Conclusions: In this uniform cohort, aNRP had lower DGF odds than SRR despite higher risk. KDPI-DGF interaction patterns were concordant in SRR-DCD kidneys but less clear in aNRP-DCD; however, formal interaction was not significant. These findings suggest that aNRP-DCD may modify early graft risk; however, larger studies with longer follow-up are needed to determine whether aNRP-DCD affects longer-term outcomes or KDPI performance.
ABSTRACT Purpose This study compared lung transplant outcomes between cases using controlled hypothermic storage (CHS) donor lung transport with ischemic times > 6 h and those using cold static storage (CSS) transport with ischemic times < 6 h. Methods We retrospectively reviewed lung transplantations performed at our center from September 15, 2014 to March 29, 2025, excluding ex vivo lung perfusion, single‐lung, redo, and multi‐organ cases. Perioperative outcomes were assessed using univariate, multivariable, survival, and propensity‐matched analyses. Results Among 770 recipients, 87 (11.3%) and 683 (88.7%) received lungs preserved using CHS and CSS, respectively. In the CHS group, ischemic times were significantly longer (median, 11.0 vs. 4.3 h, p < 0.001), and transport distances were greater (median, 750 vs. 219 nautical miles, p < 0.001). CHS was associated with higher rates of daytime transplantation (79% vs. 51%, p < 0.001) and delayed chest closure (22% vs. 13%, p = 0.023). Primary graft dysfunction grade 3 (PGD3) at 72 h was lower in the CHS group (13% vs. 26%, p = 0.019), and CHS was independently associated with a lower risk of PGD3 on multivariable analysis (aOR 0.38, 95% CI 0.17–0.83, p = 0.016). In a propensity‐matched analysis, PGD3 at 72 h was lower in the CHS group, but the difference did not reach statistical significance (12% vs. 26%, p = 0.059). Kaplan–Meier analysis demonstrated similar survival between groups ( p = 0.53). Conclusion CHS enables the safe extension of ischemic time beyond conventional limits, facilitating broader geographic access and a shift toward increased daytime transplantation. Short‐term outcomes were comparable to those of CSS, with a lower incidence of PDG3.
ABSTRACT Background Donation after circulatory death (DCD) is an increasingly important source of organs and tissues, yet differences between DCD and donation after brain death (DBD) among trauma donors remain incompletely characterized. We compared DCD and DBD donors among trauma patients who proceeded to donation. Methods Adult trauma patients who died during hospitalization across four trauma centers from January 1, 2016, through July 15, 2022, were retrospectively screened; the analytic cohort comprised patients who proceeded to donation. Multivariable logistic regression examined factors associated with DCD versus DBD among donors. Results Among 173 donors, 90 (52%) were DCD and 83 (48%) were DBD. Compared with DBD donors, DCD donors were older (median 52 vs. 31 years, p = 0.006), more often White (78% vs. 47%, p < 0.001), had fewer severe head/neck injuries (AIS ≥ 3: 61% vs. 87%, p < 0.001), higher admission GCS (13–15: 24% vs. 8%, p = 0.003), and were less often admitted to the ICU (79% vs. 98%, p = 0.002). DCD donors had a lower median number of organs and tissues recovered (2 [IQR 1–3] vs. 3 [2–4], p < 0.001). After adjustment, GCS 9–15 vs. 3–8 (AOR 3.62, 95% CI (1.22–10.77)), White race (5.41, (2.24–13.06)), head/neck AIS ≤2 vs. ≥ 3 (5.15, (1.99–13.34)), and trauma center were independently associated with DCD. Conclusions Among trauma donors, DCD and DBD donors differed in neurologic injury severity, hospital course, and organ and tissue recovery patterns. Studies that include all potential trauma donors are needed to identify factors that may influence referral, authorization, and conversion.
ABSTRACT Introduction Dual kidney transplantation (DKT) may expand the donor pool from adult donors with limited renal functional capacity. Methods Single center retrospective review of outcomes in DKT recipients. All patients received antibody induction with tacrolimus/mycophenolate/steroids. Recipient selection was based on low immunological risk (low PRA, primary transplant), limited nephron need (older age, lower BMI), and out‐of‐sequence allocation. Results Over 24 years, 100 DKTS were performed. Mean KDPI was 85%; 88 (88%) were managed with hypothermic machine preservation; 45 (45%) were imported, and mean cold ischemia time was 26.8 ± 7.4 h for the first kidney. Mean donor and recipient ages were 59.7 ± 17.5 and 60.0 ± 14.8 years, respectively. Mean pre‐DKT waiting and dialysis times were 11.3 ± 22 months and 26.5 ± 35 months, respectively. Delayed graft function occurred in 28% (2 primary nonfunction). At 12 months, mean serum creatinine was 1.49 ± 2.0 mg/dl and GFR 55 ± 25 mL/min/1.73m 2 in DKT recipients. 79 DKT patients (79%) had at least 10‐year follow‐up. Compared to 428 concurrent single KTs from high KDPI donors, patient and graft survival rates and renal function were superior in the DKT group; death‐censored graft survival was not different. Projected kidney half‐lives for DKT and high KDPI single KTs were 7.8 years and 5.9 years, respectively. With changes in kidney allocation, the number of DKTs decreased from 9.0 to 2.7 to 1.6/year. Conclusion DKTs using kidneys from medically complex donors that otherwise might be discarded provide acceptable long‐term outcomes and can improve access for older recipients. However, changes in allocation have had a negative effect on DKT activity.
