Recipients of ECD and SCD Kidney From the Donors Age 50-59 Have Comparable Outcomes: A Matched Pair Analysis.

Abstract

Background: Both donor and recipient characteristics play a role in kidney transplant (tx) outcome. Using a large database to look at risks, the SRTR defined an expanded criteria donor (ECD) as one whose kidneys are associated with ≥ 1.7 risk of graft failure versus a standard criteria donor (SCD). Because of the worse results, use of kidneys from donors meeting ECD criteria has been limited. It is unclear whether worse outcomes are due to: a) worse kidney function at the time of tx, b) more rapid decline in renal function over time; and/or c) recipient characteristics. We compared outcomes of 49 recipients of ECD kidneys from donors 50-59 vs. 66 matched recipients of SCD kidneys (from donors 50-59). Recipients were matched on age at transplant, gender, date of transplant, type 1 diabetes prior the transplant, and primary versus retransplant. We compared eGFR levels at 1 and 12 months, slope of 1/Cr vs time in the first year, and separately, after the 1st year posttransplant. Results: There were no differences in demographics between the 2 groups except in race (ECD: 86% C, 0%AA, 4% other; SCD: 85%C, 0%AA, 14% other). Mean ECD recipient age was 50±14 years; SCD, 51±14 years (NS). Patient survival, graft survival, and death censored graft survival were not different between groups ( table 1).Table: No Caption available.Mean eGFR at 1 month was 41.3±19.6 for ECD and 37.2±14ml/min/1.73m2 for SCD; at 12 months was 43.1±17.9 for ECD and 36.4±15.8 ml/min/1.73 m2 for SCD (NS). Slope of 1/Cr vs time did not differ between ECD and SCD within first year; similarly, there was no difference after the 1st yr (table2).Table: No Caption available.Conclusion: ECD transplants from donors 50-59 (at least as selected at our institution), compared to recipient-matched SCD tx, have similar 1-yr intercept and similar post 1-yr slope of 1/Cr vs time. In matched recipients, ECD tx with 1 yr survival are associated with equivalent 60 month slopes of 1/Cr vs time as SCDs.