Vascular Complications Following Kidney Transplantation From Uncontrolled Donation After Circulatory Death: A Prospective Study.

INTRODUCTION: Vascular complications in kidney transplantation are a major concern. While kidneys from uncontrolled donation after circulatory death (uDCD) offer a viable organ source, the incidence of vascular complications in these cases remains poorly studied. This study aims to compare the vascular complications between transplants from uDCD and donation after brain death (DBD). METHODS: Between January 2016 and November 2023, we performed a prospective analysis concerning vascular complications (arterial and venous) based on kidney transplants from uDCD and DBD with standard criteria (SCD) or expanded criteria (ECD). RESULTS: Among the 523 kidney transplants, 142 were from uDCD and, of those, 7.0% had vascular complications comprising arterial (2.8%) and venous (4.2%) complications. The rates of vascular complications showed no significant difference between kidney transplants from uDCD and SCD (7.0% vs. 3.1%, p = 0.120) and between uDCD and ECD (7.0% vs. 8.5%, p = 0.766). Donor age over 50 years was associated with vascular complications in uDCD (p = 0.016). The incidence of delayed graft function was significantly higher in the uDCD group compared with SCD and ECD (69.7% vs. 37.6% and 43.9%, respectively; p < 0.001). CONCLUSION: Vascular complication rates in uDCD transplantation were comparable to those in SCD and ECD transplants. Donor age appears to be a contributing factor to vascular complications in the uDCD setting. While these findings suggest similar outcomes, the small number of events highlights the need for larger studies.