Evidence map›Paper›PMID 42030318›Full record

ArticleClinical transplantation2026

Time to Death and Donation After Circulatory Death Kidney Transplant Outcomes: Opportunities for Improved Utilization in the United States.

Dharesh Raj Amarnath, Tanissha Sanjay Raj Kalpana, Georgios Kourounis, Abdullah K Malik, Jennifer Philip, Emily R Thompson, Emily Glover, Gavin J Pettigrew, Chris Callaghan, Neil Sheerin and 2 more

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Article in Clinical transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Dharesh Raj AmarnathNewcastle University School of Medicine, Newcastle upon Tyne, UK.ORCID https://orcid.org/0009-0008-9061-8766
Tanissha Sanjay Raj KalpanaNewcastle University School of Medicine, Newcastle upon Tyne, UK.
Georgios KourounisNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.
Abdullah K MalikNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.
Jennifer PhilipDivision of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Emily R ThompsonNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.
Emily GloverNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.
Gavin J PettigrewDepartment of Surgery, University of Cambridge, Cambridge, UK.
Chris CallaghanDepartment of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Neil SheerinNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.
Colin WilsonNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.
Samuel J TingleNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.

Funding

Medical Research CouncilNational Institute for Health and Care Research
6 · The paper itself

Abstract

backgroundConcerns persist that prolonged time to death (TTD) following withdrawal of life-sustaining treatment may impair organ quality. Although previous European studies have demonstrated that prolonged TTD does not impact post-transplant kidney graft survival, it remains unclear whether these findings apply to the US donor pool.

methodsWe used OPTN data on adult DCD single-kidney transplants (2010-2023). Multiple imputation was used for missing data. Multivariable regression models, with restricted cubic splines for non-linear modelling, were used to evaluate the impact of donor TTD on kidney transplant outcomes.

resultsMedian donor TTD was 14 min (IQR, 10-21 min). Donor TTD was not associated with recipient graft survival (p = 0.469), mortality (p = 0.528) or 1-year eGFR (p = 0.393). These findings were consistent regardless of normothermic regional perfusion use (NRP cohort: n = 1227; non-NRP cohort: n = 35 328), and within the large ex-situ hypothermic machine perfusion cohort (HMP- cohort: n = 22 218). Only 4.1% of transplanted DCD kidneys were from donors with TTD of over 60 min, and just 0.1% exceeded 120 min.

conclusionsIncreasing donor TTD was not associated with worse post-kidney-transplant outcomes within this cohort predominantly comprising donors with TTD 0-60 min. In contrast to this US setting, a previous UK study reported that a higher proportion of transplanted DCD kidneys were from prolonged TTD donors (12.3% from donors TTD >60 min; 4.2% from >120 min). This highlights an opportunity to safely expand the US DCD donor pool, especially in the era of machine perfusion where viability assessment may provide an additional safeguard.

Indexed as

DeathGraft RejectionKidney Failure, ChronicKidney TransplantationOrgan PreservationTissue and Organ ProcurementTissue DonorsAdultFemaleFollow-Up StudiesGlomerular Filtration RateGraft SurvivalHumansKidney Function TestsMaleMiddle Ageddonation after circulatory death (DCD)donor utilizationgraft survivalkidney transplantationmachine perfusionnormothermic regional perfusiontime to death

Identifiers

PMID42030318
PMCPMC13108833

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.