Abstract
Background The use of combined expanded criteria donor (ECD) and donation after circulatory death (DCD) kidneys is a potential strategy to expand the donor pool. Prior research showed that DCD kidneys have a slightly increased risk of graft failure vs non-DCD kidneys, but the relative risk was not significantly greater amongst ECD vs non-ECD kidneys. The Kidney Donor Risk Index (KDRI) in the ECD/DCD group was similar to those in the ECD/non-DCD group, suggesting careful selection of ECD/DCD kidneys. Methods A cross sectional study of ECD/DCD kidneys recovered from adult donors from 2000 to 2011 was conducted using the SRTR. Donor characteristics and KDRI scores of discarded and transplanted ECD/DCD kidneys were assessed and multivariable logistic regression models were used to determine the odds of discard based on donor factors. Results There were 894 ECD/DCD kidneys included in the study, of which 34.2% were discarded. The median KDRI in transplanted vs discarded organs was 1.78 (IQR 0.69) vs 1.98 (IQR 0.89), respectively (P < 0.001) although the distribution of KDRI scores between discarded and transplanted kidneys showed considerable overlap.Figure: No Caption available.In logistic regression models, the odds of discard were higher if ECD/DCD kidneys were recovered from diabetic donors (OR 1.68 [95% CI 1.16, 2.45] P = 0.007) and hepatitis B or C positive donors (OR 2.73 [95% CI 1.37, 5.43] and OR 4.16 [95% CI 1.56, 11.08], P = 0.004 for both). Pulsatile machine perfusion was associated with decreased odds of discard (OR 0.32 [95% CI 0.22, 0.44], P < 0.001). Other factors such as age, race, death by CVA, hypertension and weight were not associated with increased odds of discard. Conclusions This study demonstrates a high discard rate of ECD/DCD kidneys, some of which may be acceptable for transplantation given their favorable donor characteristics and KDRI scores.
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