{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T03:30:42Z","timestamp":1790307042124,"version":"4.1.0"},"reference-count":36,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2026,8,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify the survival benefit of deceased donor kidney transplantation versus continued dialysis according to patients\u2019 characteristics (age, diabetes, cardiovascular disease), donor quality (standard criteria donor or expanded criteria donor) and donor retrieval type (donation after brain death or donation after circulatory death).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Target trial emulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>European Renal Association Registry data from five countries or regions: Catalonia (Spain), Denmark, France, Norway, and the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients aged \u226520 years receiving dialysis and waitlisted for a first deceased donor kidney-only transplant between 2000 and 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Five year patient survival following deceased donor kidney transplantation versus continued dialysis within monthly sequential trials. Flexible parametric spline models estimated adjusted five year patient survival across recipient age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 64\u2009036 waitlisted patients receiving dialysis, 39\u2009244 received a deceased donor kidney transplant: 16\u2009897 (43.1%) from a standard criteria donor\/donation after brain death donor, 4324 (11.0%) from a standard criteria donor\/donation after circulatory death donor, 14\u2009799 (37.7%) from an expanded criteria donor\/donation after brain death donor, and 3224 (8.2%) from an expanded criteria donor\/donation after circulatory death donor. Standard criteria donor\/donation after brain death and standard criteria donor\/donation after circulatory death transplantation showed higher estimated five year survival compared with continued dialysis regardless of recipient age. However, the survival benefit associated with expanded criteria donor\/donation after brain death transplantation and, particularly, expanded criteria donor\/donation after circulatory death transplantation decreased with increasing recipient age, albeit with greater statistical uncertainty among older patients. For example, among 75 year olds, estimated five year survival following expanded criteria donor\/donation after circulatory death transplantation did not differ significantly from that with continued dialysis (59% (95% confidence interval 51% to 66%) versus 55% (54% to 55%); hazard ratio 0.97, 95% confidence interval 0.70 to 1.33), irrespective of diabetes or cardiovascular disease status. This group had a threefold higher early post-transplant mortality than those continuing dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Standard criteria donor kidney transplantation was consistently associated with a survival benefit compared with continued dialysis. By contrast, the survival benefit associated with expanded criteria donor transplantation declined with increasing recipient age, particularly for expanded criteria donor\/donation after circulatory death transplantation, such that the oldest recipients had a smaller and more statistically uncertain estimated survival advantage over continued dialysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2026-100624","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:05:19Z","timestamp":1789729519000},"page":"e100624","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Survival benefit of deceased donor kidney transplantation versus continued dialysis: international target trial emulation"],"prefix":"10.1136","volume":"394","author":[{"given":"Rachel","family":"Hellemans","sequence":"first","affiliation":[{"name":"Department of Nephrology, Antwerp University Hospital, Edegem, Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas C","family":"Chesnaye","sequence":"additional","affiliation":[{"name":"ERA Registry, Department of Medical Informatics, Amsterdam UMC, Amsterdam, Netherlands"},{"name":"Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke","family":"Kramer","sequence":"additional","affiliation":[{"name":"ERA Registry, Department of Medical Informatics, Amsterdam UMC, Amsterdam, Netherlands"},{"name":"Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edouard L","family":"Fu","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miha","family":"Arnol","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"\u00c5sberg","sequence":"additional","affiliation":[{"name":"Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway"},{"name":"Department of Pharmacy, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Bistrup","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Odense University Hospital, Odense, Denmark"},{"name":"Department of Clinical Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro Manuel","family":"Ferraro","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, Universit\u00e0 degli Studi di Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Heldal","sequence":"additional","affiliation":[{"name":"Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaakko","family":"Helve","sequence":"additional","affiliation":[{"name":"Finnish Registry for Kidney Diseases, Finnish Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Legeai","sequence":"additional","affiliation":[{"name":"Organ and Tissue Procurement and Transplantation Department, Agence de la biom\u00e9decine, Saint Denis La Plaine, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Medcalf","sequence":"additional","affiliation":[{"name":"UK Renal Registry, UK Kidney Association, Bristol, UK"},{"name":"University of Leicester, John Walls Renal Unit, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothea","family":"Nitsch","sequence":"additional","affiliation":[{"name":"UK Renal Registry, UK Kidney Association, Bristol, UK"},{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Renal Department, Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Oliveras","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitari de Bellvitge, L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Jos\u00e9","family":"P\u00e9rez-S\u00e1ez","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital del Mar, Barcelona, Spain"},{"name":"Hospital del Mar Research Institute, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bel\u00e9n","family":"Ponte","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Nephrology and Hypertension Division, University Hospitals of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Savoye","sequence":"additional","affiliation":[{"name":"Organ and Tissue Procurement and Transplantation Department, Agence de la biom\u00e9decine, Saint Denis La Plaine, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e5rten","family":"Segelmark","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund 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