ECD kidneys and re-transplantation

Abstract

Dear Editor,We congratulate Ortiz and associates on this very informative paper that discusses the role of expand-ed criteria donor (ECD) kidneys in recipients with prior transplants [1]. Based on their graft and pa-tient survival data, they recommend an aggressive attitude towards utilization of these kidneys in re-transplant (RT) patients. We have a few comments about the study, but importantly, we question why RT patients are treated differently at the time of kidney allocation and discuss the risks posed by re-transplantation.The authors found RT recipients to be younger than their rst-time ECD recipients, probably be-cause of their younger age at the time of their rst transplant when they received a standard criteria donor (SCD) kidney. They found a signi cant dif-ference in delayed graft function (DGF) between ECDRT and SCDRT (42% vs. 27%), suggesting that perhaps it is the kidney quality and not the RT that is responsible for this difference in DGF. With com-parable graft and patient survival in the short term, Ortiz et al. have shown that ECD kidneys can be a useful resource even in the RT group.Ortiz et al. found that ECDRT and ECD recipients had similar outcomes. This is not surprising, be-cause both groups received ECD kidneys. More im-portantly, however, this shows that the RT status did not have a negative impact on the outcome, and that perhaps the high risk attributed to RT may be an exaggeration. The main factor that determines