Background: There are three categories of deceased donors in China now, donation after brain death(DBD), donation of cardiac death(DCD), and donation after brain and cardiac death(DBCD). The aim of this study is to compare the outcomes of kidney transplantation from these three categories of deceased donors.

Methods: We retrospectively collected the data of donors and recipients from 272 cases of deceased kidney transplantation, performed in our transplant center from July 2011 to Dec 2014, including 35 DBD donors, 62 DCD donors, and 175 DBCD donors. The recipients were followed up for at least one year. The baseline characteristics of donors and recipients were compared. The graft loss, patient death, postoperative complications and serum creatinine levels were also compared among the three groups.

Results: The mean functional warm ischemia time was much longer in DCD group compared to DBCD and DBD groups(23.4 min, 14.5min, and 0.5 min, respectively, p<0.001). The incidences of cardio-pulmonary resuscitation were higher in DCD and DBCD groups compared to DBD group(27.4% , 23.4%, and 5.7%, respectively,p=0.036). DGF rates were much higher in DCD group compared to DBCD and DBD groups(29.0%, 15.4% and 5.7%, respectively, p=0.008). 1 graft(1.6%) loss in DCD group and 4 grafts(2.3%) loss in DBCD group. 1 patient(0.6%) died of severe pneumonia in DBCD group. No graft loss or patient death in DBD group. The incidences of acute rejection and infection were comparable among three groups. Serum creatinine levels on postoperative 1 week, 1 month and 1 year were all higher in DCD group compared to DBCD or DBD groups(p<0.05). Logistic multivariate regression showed that functional warm ischemia time, donor age and hypertension history were independent risk factors for DGF.

Conclusion: DGF rate and serum creatinine levels were much higher after DCD kidney transplants compared to DBCD or DBD kidney transplants due to longer functional warm ischemia time. However the graft and patient survival were comparable.