Deceased Donor Kidney Transplant Survival Varied

A target trial emulation published in The BMJ found that deceased donor kidney transplantation was generally associated with higher estimated 5-year survival than continued dialysis, although the magnitude and statistical certainty of the benefit varied by donor type and recipient age.

The study used European Renal Association Registry data from Catalonia, Denmark, France, Norway, and the UK. It included 64,036 patients aged 20 years or older who were receiving dialysis and waitlisted for a first deceased donor kidney-only transplant between 2000 and 2019. Investigators emulated monthly sequential trials and used flexible parametric spline models to estimate adjusted 5-year survival across recipient age.

Among the waitlisted patients, 39,244 received a deceased donor transplant. Of these, 16,897 received a standard criteria kidney after brain death, 4,324 received a standard criteria kidney after circulatory death, 14,799 received an expanded criteria kidney after brain death, and 3,224 received an expanded criteria kidney after circulatory death.

Transplantation with standard criteria donor kidneys was associated with higher estimated 5-year survival than continued dialysis regardless of recipient age. In contrast, the estimated survival benefit with expanded criteria donor kidneys declined as recipient age increased, particularly for organs donated after circulatory death, and estimates were less certain among older patients.

Among patients aged 75 years, estimated 5-year survival after transplantation with an expanded criteria kidney donated after circulatory death was 59%, compared with 55% with continued dialysis. The difference was not statistically significant (hazard ratio, 0.97; 95% CI, 0.70-1.33). Early post-transplant mortality in this group was three times that among patients who continued dialysis. The investigators concluded that standard criteria donor transplantation was consistently associated with a survival benefit, whereas the estimated advantage of expanded criteria donor transplantation became smaller and more uncertain with increasing recipient age.

Source: Hellemans R, Chesnaye NC, Kramer A, et al. Survival benefit of deceased donor kidney transplantation versus continued dialysis: international target trial emulation. BMJ. 2026;394:e100624. doi:10.1136/bmj-2026-100624