Clinical Outcomes After Kidney Transplantation From Controlled Donation After Circulatory Death Donors: A Single-Center Observational Study

Introduction Controlled donation after circulatory death (cDCD) has become a key strategy to expand the kidney donor pool. The aim of this study was to evaluate the short- and mid-term outcomes of kidney transplantation from these donors in our center, with special attention to the impact of donor age. Patients and methods We performed a retrospective single-center observational study including all recipients of kidney transplantation from cDCD donors between April 2015 and December 2024. Patients were divided according to donor age: ≥65 years and <65 years. Delayed graft function (DGF), renal function, graft survival, and patient survival were analyzed using Kaplan-Meier curves and Cox regression analysis. Results A total of 171 recipients were included; 37 (21.6%) received kidneys from donors ≥65 years. DGF was more frequent in recipients of older donors (81.1% vs 49.3%; P = .002), with lower estimated glomerular filtration rate at 1 year (39 vs 52 mL/min). Death-censored graft survival was comparable between both groups (P = .29). Mortality was higher in recipients of donors ≥65 years (21.6% vs 6.7%; P = .013), with lower patient survival (P = .005). In multivariate analysis, recipient age >65 years was the only independent predictor of mortality (HR 3.9; P = .04), whereas eGFR <30 mL/min at 1 year was the only independent predictor of graft loss (HR 7.3; P = .02). Conclusion Kidney transplantation from elderly cDCD donors provides favorable mid-term outcomes and represents a safe strategy to expand the donor pool.