Expanded Criteria Donor Group Research Articles

Impact of donor expanded criteria kidney transplantation on clinical outcomes and survival: A single-center experience

IntroductionThe scarcity of suitable donor organs has led to the inclusion of Expanded Criteria Donor (ECD) kidneys to augment the donor pool, despite potential concerns regarding post-transplant outcomes. MethodsThis retrospective study analyzed the clinical outcomes of a cohort of 317 kidney transplant recipients from deceased donors at a single center between 2008 and 2018. Patients were categorized into ECD and Standard Criteria Donor (SCD) groups, with primary nonfunctioning grafts excluded. Comprehensive laboratory evaluations were conducted, including HLA typing and serum creatinine levels. Immunosuppressive regimens were standardized, and statistical analyses were performed using the SPSS program. ResultsThe sample consisted of 83 (26.18%) patients who received kidney transplants from ECDs and 234 (73.82%) from SCDs. The ECD group showed a longer cold ischemia time (p = 0.019) and a higher rate of delayed graft function (DGF) compared with the SCD group. No significant differences were observed in graft survival (p = 0.370) or patient survival (p = 0.993) between the ECD and SCD groups. However, differences in graft survival were noted between the groups when stratified by DGF status: ECD with DGF vs. ECD without DGF (p = 0.029), ECD with DGF vs. SCD with DGF (p = 0.188), ECD with DGF vs. SCD without DGF (p = 0.022), ECD without DGF vs. SCD with DGF (p = 0.014), ECD without DGF vs. SCD without DGF (p = 0.340), and SCD with DGF vs. SCD without DGF (p = 0.195). No differences in patient survival rates were observed among these groups for all pairwise comparisons (p > 0.05) when stratified by donor criteria and DGF status. ConclusionsGraft and patient survival rates were comparable between ECD and SCD kidney transplant recipients.

Long-term outcomes of kidney transplantation from expanded criteria donors with Chinese novel donation policy: donation after citizens’ death

IntroductionThe Chinese Government initiated the Donation after Citizens' Death policy in 2010. To now, it has been a major source of organs for transplant. Since it is still a young policy, corresponding clinical evidence is still urgently needed for its improvement. Compared to kidneys donated by SCD (standard criteria donor), increasing the use of ECD (expanded criteria donor) derived kidneys is a way to expand the donor pool but is also a result of the aging demography of China. This study is based on the data of kidney transplantation in our center with the Donation after Citizens' Death policy, aiming to provide a reference for the clinical use of ECD kidneys.MethodA retrospective study enrolled 415 kidney transplants derived from 211 donors performed between October 2011 and October 2019. A total of 311 (74.9%) organs were donated from 159 (75.4%) SCDs, and the remaining 104 (25.1%) were from 52 (24.6%) ECDs. The log-rank test was used to compare the difference in survival and postoperative complications. The Chi-square test was used to compare the occurrence of postoperative complications and postoperative renal function. The Cox regression analysis was used for risk factor screening.ResultAnalysis showed that grafts from ECD were poorer in survival (P = 0.013), while their recipients had comparable (P = 0.16) survival. Moreover, it also was an independent risk factor for graft loss (HR 2.27, P = 0.044). There were significantly more AR occurrences in the ECD group compared with SCD group (25.0% vs. 15.8%, P = 0.004), but no significant difference was found in infection (51.9% vs. 47.6%, P = 0.497) and DGF (26.0% vs. 21.9%, P = 0.419) between them. Similarly, fewer recipients in the ECD group were free from AR within 1 year after transplantation (P = 0.040), with no statistical difference in all-cause infection prevalence in 1 year (P = 0.168). The eGFR in the ECD group was significantly worse than that in the SCD group at 3 months, 6 months, 1 year, 3 years, and the highest value posttransplant (all < 0.05), but no difference at 5 years posttransplant. Besides, results showed cardiac arrest (uncontrolled vs. controlled, HR 2.49, P = 0.049), HLA mismatch (4–6 loci vs. 0–3 loci, HR 3.61, P = 0.039), and AR occurrence (HR 2.91, P = 0.006) were demonstrated to be independent risk factors for graft loss.ConclusionThe ECD-derived kidney was worse than the SCD-derived kidney in terms of graft survival and AR occurrence, and trend to an inferior renal function postoperative. However, the recipient survival, DGF occurrence, and all-cause infection occurrence were similar.

Are Kidney Donor Risk Index/Kidney Donor Profile Index Scores Predictor of Future Graft Function?

Kidney donor profile index (KDPI) is a method developed to assess donor kidney quality for cadaveric transplants. We investigated the relationship between kidney donor risk index (KDRI) and KDPI scores of cadaveric transplants in the last five years in our clinic and current graft conditions. Forty people (12 females, 28 males; mean age, 46.35 + 8.94 years), who underwent cadaveric transplantation between January 2013 and March 2018, were participated in this study. At the same time, the KPDI and KDRI scores of the donor's kidneys were calculated and then compared with that of the recipients' data. The mean KDRI value of donors was 1.11 ± 0.33 and the median KDPI value was 60.50%. KDRI/KDPI scores were found to be high in women (P = 0.021) and, when the posttransplant findings of the recipients were evaluated by bivariate correlation analysis KDRI/KDPI scores were positively correlated with the day when creatinine (Cr) values started to fall off spontaneously (r = 0.457, P = 0.003). It was observed that recipients who were transplanted from the donors with high KDRI/KDPI scores had higher Cr levels (P <0.01) and this relationship did not change over time (P = 0.115). When the donors were grouped as the standard-criteria donor and expanded-criteria donor (ECD); we found that the relationship between KDRI/KDPI, creatinine, and time was more significant in the ECD group (P = 0.04). KDRI/KDPI scores are closely related to graft outcomes especially in recipients that have kidneys from marginal donors. Therefore, evaluation of KDRI/KDPI scores might be required in marginal donors.

Effects of expanded allocation programmes and organ and recipient quality metrics on transplant-related costs in kidney transplantation - an institutional analysis.

Expansions of donor pools have a controversial impact on healthcare expenditures. The aim of this study was to investigate the emerging costs of expanded criteria donor (ECD) kidney transplantations (KT) and to identify independent risk factors for increased transplant-related costs. We present a retrospective explorative analysis of hospital costs and reimbursements of KTs performed between 2012 and 2016 in a German university hospital. A total of 174 KTs were examined, including 92 (52.9%) ECD organ transplantations. The ECD group comprised 43 (24.7%) 'old-for-old' transplantations. Median healthcare costs were 19570€ (IQR 18735-27405€) in the standard criteria donor (SCD) group versus 25478€ (IQR 19957-29634€) in the ECD group (+30%; P=0.076). 'Old-for-old' transplantations showed the highest healthcare expenditures [26702€ (19570-33940€)]. Irrespective of the allocation group, transplant-related costs increased significantly in obese (+6221€; P=0.009) and elderly recipients (+6717€; P=0.019), in warm ischaemia time exceeding 30min (+3212€; P=0.009) and in kidneys with DGF or surgical complications (+8976€ and +10624€; both P<0.001). Transplantation of ECD organs is associated with incremental costs, especially in elderly and obese recipients. A critical patient selection, treatment of obesity before KT and keeping warm ischaemia times short seem to be crucial, in order to achieve a cost-effective KT regardless of the allocation group.

A New Risk Stratification Score for Deceased Donor Kidneys in Korea

Organ shortages have led to expansions in the criteria for deceased donors. Although the expanded criteria donor (ECD)/standard criteria donor (SCD) dichotomous criteria have been useful for making decisions about accepting organ offers, several studies reported that these criteria are too simple to predict prognosis sufficiently. The Kidney Donor Risk Index (KDRI) is based on 10 donor factors, therefore providing a finely granulated evaluation of donor kidney quality. Kidney Donor Profile Index (KDPI) that was derived from KDRI, was newly adopted as an alternative to ECD/SCD in the US. However, the KDPI based on US data may not have similar prognostic values in other countries. Here, we developed a Korean risk stratification score for deceased donor kidney using data obtained from the KONOS (Korean Network for Organ Sharing) and KOTRY (Korean Organ Transplantation RegistrY), and investigated its prognostic values. We analyzed 5,524 first-time, deceased donor adult kidney transplants between 2000 and 2016. A Cox regression model was used to find out independent risk factors among donor and transplant-related factors for graft failure, adjusted for recipient characteristics. There were 426 deaths and 483 graft loss during median follow-up of 49 months. The mean age of donors were 44 years old, and 32% of donor were females. Nine hundred seventeen donors had history of hypertension, and the cause of death was cerebrovascular event in 2,597 donors. Fifty-three donated organ after cardiac death, and mean cold ischemic time was 322 minutes. Twenty-three percent belonged to ECD. Median KDRI was 1.18 and KDPI was 67. A New Korean Kidney Donor Risk Index (K-KDRI) includes 6 donor and transplant factors, each found to be independently associated with graft failure: donor age, weight, history of diabetes, serum creatinine, cerebrovascular cause of death, and HLA mismatch. Median K- KDRI was 1.5. A New Korean Kidney Donor Profile Index (K-KDPI) is a remapping of the K-KDRI onto a cumulative percentage scale. The lowest K-KDPI group (<20%) showed better graft survival than the higher K-KDPI groups (20-80%, ≥80%, respectively) (p<0.001). Even within the ECD group, higher K-KDPI values were significantly associated with lower graft survival rate. In contrast, in the same K-KDPI group, there was no difference in graft survival rate between ECD and SCD. These data suggested that K-KDPI is a better prognostic tool for graft outcomes than the previous ECD/SCD criteria. The new K-KDPI criteria based on the Korean data are expected to give better information about graft prognosis and assist decision making for deceased donor kidney utilization in Korea. KONOS (Korean Network for Organ Sharing). KOTRY (Korean Organ Transplantation Registry).

Impact of Korea Network for Organ Sharing Expanded Donor Criteria on Delayed Graft Fuction in Kidney Transplantation: A Single-Center Experience

BackgroundThe shortage of donor organs has been a major challenge in transplantation. In an effort to reduce the donor shortage, kidney transplantation (KT) using expanded criteria donors (ECD) was encouraged. In Korea, transplantation centers used the Korea Network for Organ Sharing (KONOS) ECD criteria, which is different from the United Network for Organ Sharing (UNOS) criteria. The aim of this study is to evaluate the predictive power of KONOS criteria on delayed graft function (DGF) in comparison to UNOS criteria. MethodsA total of 376 recipients who underwent deceased donor kidney transplantation between January 2005 and December 2014 at Severance Hospital were retrospectively reviewed. Of these, 130 cases satisfied KONOS ECD, while the others followed KONOS standard criteria donor (SCD). ResultsDonor age and history of hypertension was significantly higher with KONOS ECD than with KONOS SCD. In KONOS subgroup analysis, donor characteristics were different than with UNOS criteria. The incidence of DGF was higher in the KONOS ECD group than in the KONOS SCD group. However, UNOS ECD showed a high incidence of DGF compared to UNOS SCD with the same KONOS criteria. UNOS ECD was an independent risk factor for DGF in multivariate analysis. However, KONOS ECD was not a risk factor for DGF. Although glomerular filtration rate was inferior in the KONOS ECD group compared to the KONOS SCD group, the UNOS SCD group within the KONOS ECD group showed similar graft function compared to the KONOS SCD group. ConclusionKONOS criteria have a lower predictive power for DGF than UNOS criteria.

Similar Outcomes of Kidney Transplantations Using Organs From Donors After Cardiac Death and Donors After Brain Death

BackgroundTo increase the number of cadaveric kidney transplants in Japan, it is necessary to proactively use organs from all donors. Since the revision of the Organ Transplant Law, the number of organ donors after cardiac death (DCD) has decreased but the number of organ donors after brain death (DBD) has increased; however, the number of donor organs and awareness of cadaveric transplantation have increased. MethodsAt our institution, 28 patients underwent cadaveric kidney transplantation from January 2001 to December 2016. These patients were classified into 2 groups according to DBD or DCD. Furthermore, 10 patients received transplants from expanded criteria donors (ECD) and 18 received them from standard criteria donors (SCD). ResultsKidney graft survival and engraftment were observed for all patients. There were no significant differences in renal function at 6 months for DBD and DCD transplant recipients. Renal function at 1, 3, and 5 years and serum creatinine levels were better for the ECD group. Renal function at 5 years after transplantation was significantly better for the SCD group than for the ECD group; however, there was no difference in delayed graft function between the SCD and ECD groups. Comparisons of the 3 groups showed good renal function for transplants from DBDs, but there was no significant difference in survival rates. ConclusionsResults were good for all patients. There were no significant differences in outcomes of our patients who received transplants from ECD or SCD.

Validation of KDRI/KDPI for the selection of expanded criteria kidney donors

IntroductionKDRI/KDPI are tools use in kidney donor evaluation. It has been proposed as a substitute of, or complementary to preimplantation renal biopsy. These scores have not been validated in Spain. Objective(1) To investigate the concordance between KDPI and histological scores (preimplantation renal biopsy) and (2) to assess the relationship between KDRI, KDPI and histological score on graft survival in the expanded criteria donors group. MethodologyRetrospective cohort study from 1 January 1998 to 31 December 2010. ResultsDuring the study 120 donors were recruited, that resulted in 220 preimplantation renal biopsies. 144 (65%) grafts were considered suitable for kidney transplantation. 76 (34.5%) were discarded. Median follow up has been 6.4 years (sd 3.9). Median age 63.1 years (sd 8.2), males (145; 65.9%), non-diabetic (191; 86.8%) and without another cardiovascular risk factors (173; 78.6%). 153 (69.5%) donors died of cerebrovascular disease. There were significant differences in KDRI/KDPI score in both groups 1.56/89 (sd 0.22) vs 1.66/93 (sd 0.15), p<0.01. The KDPI showed moderate concordance and correlation with the histological score (AUC 0.64/correlation coefficient 0.24, p<0.01). KDPI (HR 24.3, p<0.01) and KDRI (HR 23.3, p<0.01) scores were associated with graft survival in multivariate analysis. Conclusion(1) KPDI and histological scores show moderate concordance. The utility of both scores as combined tools it has to be determined. (2) KDPI score, and especially KDRI score, are valid for estimating graft survival and combined with the biopsy can help to individualized decision making in the expanded criteria donors pool.

Perfusion Parameters of Donation After Cardiac Death Kidneys Predict Early Transplant Outcomes Based on Expanded Criteria Donor Designation

BackgroundDonation after cardiac death is the only source of the deceased donor in China at present. Hypothermic machine perfusion has been used increasingly over the years. We determined the hypothermic machine perfusion parameters associated with early transplant outcomes based on the expanded criteria donor (ECD) designation. MethodsThere were 446 consecutive kidneys donated after cardiac death and preserved by hypothermic machine perfusion (LifePort) in our center that were included in this study. The database was divided into 2 groups: ECD and non-ECD groups. LifePort parameters and other pretransplant factors were analyzed. Logistic regression analysis was used to determine the significant factors for delayed graft function (DGF). Recovery time for renal function and 6-months serum creatinine were investigated. ResultsThe DGF rates were 20.25% and 11.72% in ECD and non-ECD group by our definition, respectively (P = .042). Higher pressures allowed comparable increases of flow in ECD kidneys despite still greater resistance. For non-ECD kidneys with an initial flow of ≤80 mL/min, the DGF rate of the subgroup with a terminal flow of ≥100 mL/min was significantly lower compared with that of other terminal flow subgroups (≤80 and 90–100 mL/min; P < .05), and showed a trend toward significance when compared with the terminal flow subgroup of 80 to 90 mL/min (P = .098). Terminal resistance was the most significant parameter predicting DGF (odds ratio 2.44; P < .001), and remained significant after adjusted for other relevant pretransplant variables. Logistic model for DGF (model: terminal resistance, hypotension in agonal phase, terminal serum creatinine, and cause of death) had good predictive ability (c-statistic 0.851; 95% confidence interval, 0.799–0.903). ConclusionsLifePort parameters provided a granular measurement easily accessible in evaluating the quality of kidneys donated after cardiac death that added information to ECD criterion.

Association of Brain-Dead Donors' Terminal Inflammation With Delayed Graft Function in Kidney Transplant Recipients

BackgroundSystemic inflammation affects kidney function in a wide range of diseases. Even in kidney transplant recipients, higher levels of C-reactive protein (CRP) are invariably associated with both worse short- and long-term graft outcomes. However, little is known about systemic inflammation in kidney donors and, notably, brain death causes a strong systemic inflammatory response. ObjectiveTo analyze the role of systemic inflammation of brain-dead donors on short-term kidney graft outcomes (ie, delayed graft function [DGF], defined as the need of dialysis during the first week after transplantation). Materials and methodsRetrospective analysis of clinical and biochemical characteristics of all brain-dead kidney donors generated in the Hospital Clínic of Barcelona in the 2006 to 2015 period (n = 194). Donors who were tested for CRP in the 24 hours before BD declaration were included (n = 97, 50% of initial population). Clinical and biochemical features of their respective recipients (n = 165) were analyzed, comparing recipients who developed DGF (n = 30) with recipients who did not (n = 135). ResultsDonors whose recipients later developed DGF had much higher CRP values (10.58 [5.1-18.21] vs 4.81 [1.42-12.2] mg/dL, P = .025). Other characteristics associated with the development of DGF were renal biopsy score and recipient dialysis vintage (P = .025 and P = .002, respectively). In logistic regression analysis, PCR maintained significance in the non–expanded criteria donor (ECD) group (odds ratio [OR], 1.102; P = .027), but it lost significance in the ECD group (P = .67). ConclusionsTerminal donor CRP was associated with DGF in kidney transplant recipients and proved to be mostly significant in younger donors.

Validación del KDRI/KPDI para la selección de donantes renales con criterios expandidos

IntroductionKDRI / KDPI are tools use in kidney donor evaluation. It has been proposed as a substitute of, or complementary to preimplantation renal biopsy. These scores has not been validated in Spain. Objective1) To investigate the concordance between KDPI and histological scores (preimplantation renal biopsy) and 2) To assess the relationship between KDRI, KDPI and histological score on graft survival in the expanded criteria donors group. MethodologyRetrospective cohort study from 1 January 1998 until 31 December 2010. ResultsDuring the study 120 donors were recruited, that resulted in 220 preimplantation renal biopsies. 144 (65%) grafts were considered suitable for kidney transplantation. 76 (34.5%) were discarded. Median follow up has been 6.4 years (sd 3.9). Median age 63.1 years (sd 8.2), males (145; 65.9%), non-diabetic (191; 86.8%) and without another cardiovascular risk factors (173; 78.6%). 153 (69.5%) donors died of cerebrovascular disease. There were significant differences in KDRI/KDPI score in both groups 1.56/89 (sd 0.22) vs 1.66/93 (sd 0.15), p<0.01). The KDPI showed moderate concordance and correlation with the histological score (AUC 0.64 / correlation coefficient 0.24, p <0.01). KDPI (HR 24.3, p<0.01) and KDRI (HR 23.3, p<0.01) scores were associated with graft survival in multivariate analysis. Conclusion1) KPDI and histological scores show moderate concordance. The utility of both scores as combined tools it has to be determined. 2) KDPI score, and especially KDRI score, are valid for estimating graft survival and combined with the biopsy can help to individualized decision making in the expanded criteria donors pool.

Effects of Cold Ichemic Time on Allograft Survival in Kidney Transplantation From Expanded Criteria Donor

Backgrounds Kidney organ shortage is a major problem for transplant communities around the world. Kidneys from expanded criteria donors (ECD) is increasingly accepted and widely used by many transplant programs. However, kidney allograft survivals from ECD is believed to be lower compared to standard criteria donors (SCD) due to lower nephron numbers. Objectives To demonstrate factors correlated with poor allograft survival from ECD. Methods Using Thai transplantation registry data from 1994 to 2016, 2,886 adults (>18 years) first deceased donor kidney transplant recipients were included into the study. Of those, 242 (8.39%) were kidney transplantation from expanded criteria donor which was defined as donor age of more than 60 year or donor age between 50 to 60 years with two of the following characteristics including history of hypertension, last serum creatinine of more than 1.5 mg/dl, and death from stroke. Results Mean recipient age and donor age were significantly higher in ECD group (for recipient age, 48.6±11.8 vs 44.7±11.3 years in SCD group, p<0.001; for donor age, 60.1±5.7 vs 34.5±13.0 years in SCD group, p<0.001). Not surprisingly, cold ischemic time (CIT) is longer in ECD group (20.2±5.0 vs 19.0±6.5 hours in SCD group, p=0.006) and delayed graft function is higher (59.7% vs 42.4%, p<0.001). ECD group increased risk of allograft loss when compared to SCD group (HR 2.19, 95% CI 1.65 to 2.91, p <0.001). However, in patients with CIT of less than 18 hours, the effects of ECD was disappeared (HR 1.58, 95% CI 0.83 to 3.01, p=0.165), compared to group of patients with CIT of more than 18 hours (HR 2.29, 95% CI 1.61 to 3.24, p <0.001) as shown in the figure. Conclusions Kidney transplantation from ECD increases the risk of allograft failure. However, this effect is vanished if CIT is less than 18 hours. Transplant coordinators from 31 kidney transplant centers across Thailand.

Long-Term Outcomes of Kidney Transplantation From Expanded-Criteria Deceased Donors: A Single-Center Experience

BackgroundOrgan shortage has prompted the use of expanded-criteria donors (ECDs). Our objective was to compare long-term outcomes of kidney transplants from ECDs with those from concurrent standard-criteria donors (SCDs). In addition, we evaluated variables associated with graft survival in both groups. MethodsWe retrospectively reviewed all 617 deceased-donor kidney transplantations performed from 2005 to 2009 in our department. The population was divided according to donor status into ECD or SCD. Patients were followed until 5 years after transplantation, death, graft failure, or loss to follow-up. ResultsWe transplanted 150 deceased-donor kidneys from ECDs and 467 from SCDs. ECD were older, more frequently women, had a lower pre-retrieval glomerular filtration rate, and more frequently died due to cerebrovascular accident. ECD recipients were older, presented a lower proportion of black race, more frequently were on hemodialysis, and presented a higher rate of first kidney transplants. Mean glomerular filtration rate was consistently lower in the ECD group. Patient and graft survivals were lower in the ECD group, but statistical significance was present only in graft survival censored for death with a functioning graft at 3 years and graft survival noncensored for death with a functioning graft at 5 years. Younger recipient ages, longer time on dialysis, acute rejection episodes, and glomerular filtration rate at 1 year after transplantation were independent risk factors for lower graft survival. ConclusionsTransplantation with the use of ECD kidneys provide quite satisfactory patient and graft survival rates despite their poorer long-term outcomes.

Study of Cadaveric Kidney Transplantation: A Single Center Experience

BackgroundTo increase the number of cadaveric kidney transplants in Japan, it is necessary to proactively perform transplantation from marginal donors. We had the opportunity to frequently perform kidney transplantation from expanded-criteria donors (ECDs), and it is anticipated that there will be increases in the number of ECD kidney transplants. MethodsIn our institution, 18 patients underwent cadaveric kidney transplantation from January 2001 to December 2011. Sixteen of those patients were classified into 2 groups according to donation after brain death (BD) or after cardiac death (CD). We also classified donors as ECDs or standard-criteria donors (SCDs). ResultsKidney graft survival and engraftment were observed in all of the patients. Renal function at 1 year after transplantation was significantly better in the BD group than in the CD group. However, there was no significant difference between the groups in renal function at 3 and 5 years. Renal function at 1 and 3 years after transplantation was significantly better in the SCD group than in the ECD group, but there was no difference in renal function between the SDC and ECD groups at 5 years. ConclusionsThe results were good for all of the patients. There are many reports that graft survival rate at 3–5 years after transplantation from ECDs is poorer than from SCDs. However, no statistically significant difference was found in kidney function at ≥5 years between the ECD and SCD groups in our patients.

Outcomes in Renal Transplantation with Expanded-Criteria Donors

BackgroundKidney transplantation is the treatment of choice for patients with end-stage renal disease. In recent years donor criteria have changed to increase the percentage of expanded-criteria donors (ECDs). The aim of this study was to analyze transplants from ECDs obtained at our institution from. 2010 to 2012. We studied the comorbidity of ECD, preimplantation histologic study, renal function, and survival of transplanted grafts. Patients and MethodsEighty ECDs (160 kidneys) were analyzed. Forty-nine grafts were not implanted owing to macroscopic lesions (37 kidneys) or histologic findings on preimplantation biopsy (12 kidneys). Finally, 60 grafts from ECDs were implanted in our center. We analyzed the characteristics of the grafts (kidney function, creatinine clearance) and compared the data with a control group of allografts from standard-criteria donors (n = 14). ResultsThe median age of the ECD group was 72 years (range 65–77). No differences were found in certain characteristics between the ECDs whose kidneys were or were not implanted (hypertension, diabetes, creatinine at the time of the donation or proteinuria). However, there were differences in donor age (75 vs 67; P = .043), increased preimplantation biopsy score (6.8 ± 1.3 vs 4.8 ± 1.1; P = .041), and a higher percentage of cardiovascular disease (62.5% vs 43%; P = .038). Comparison of ECD and non-ECD grafts showed a lower creatinine clearance at 1 year (50 ± 05 mL/min vs 69 ± 96 mL/min, respectively; P < .001) and 2 years (50 ± 07 mL/min vs 67 ± 74 mL/min; P < .001) after transplantation. There were no differences in delayed graft function or graft survival between the 2 groups at 2 years after transplantation (95% vs 100%; P = .38). ConclusionsWe found no differences in graft survival from ECD compared with the control group of standard-criteria donors. The evaluation of grafts from ECD may be a strategy to increase the number of kidney transplants.

Risk factors and outcome of expanded-criteria donor kidney transplants in patients with low immunological risk

The aim of this study was to evaluate risk factors and outcome of expanded-criteria donor (ECD) kidney transplants in patients with low immunological risk. We evaluated graft survival and graft function in 265 recipients with low immunological risk defined as the absence of pretransplant donor-specific HLA antibodies. A total of 112 (42%) kidneys derived from ECD and 153 (58%) from standard-criteria donors (SCDs). Overall, in a multivariate Cox regression, ECD status was the only significant risk factor for graft failure (hazard ratio [HR] 2.31, 95% confidence interval [CI] 1.22-4.37; p = 0.01). In the SCD group there was an increased risk for graft failure with increasing recipient age (HR 1.06 per year, CI 1.01-1.10; p = 0.02) and in the ECD group a trend for risk reduction for recipients treated with tacrolimus (Tac) (HR 0.46, CI 0.20‒1.06; p = 0.07). One, three and five-year graft survival of ECD kidneys was significantly better when recipients were treated with Tac (95%, 88% and 72%, respectively) than when they were treated without Tac (73%, 65% and 50%, respectively) (p = 0.008). At three years, ECD kidneys had a lower median estimated creatinine clearance (eCrCl) than SCD kidneys (37 vs 58 ml/min, p <0.001). Within the ECD group, recipients treated with Tac had a higher median eCrCl than those treated without Tac (41 ml/min vs 33 ml/min, p = 0.004). Graft function from one to three years was preserved in ECD recipients treated with Tac (median change 0.0 ml/min, p = 0.4) compared with those treated without Tac (median change -3.2 ml/min, p = 0.005). Tac-based immunosuppression seems to improve graft survival and to preserve graft function in ECD kidneys with low immunological risk.

Current status of pediatric donor en bloc kidney transplantation to young adult recipients

Context and objectivesIn recent years, despite the increased number of kidney transplants performed in Spain, we observed a gradual increase in waiting lists. The need to increase the number of transplants performed in our centers forces us to accept as donors the patients previously rejected. Acquiring of evidenceWe performed a systematic review using PubMed of published articles in the last 10 years, that include the words trasplante renal en bloque, “en bloc kidney transplantation” or its initials EBKT. Synthesis of evidenceThe pediatric donor to adult recipient has been included in the expanded criteria donors group, such donors being rejected nevertheless in most centers. However, in recent published series comparing the en bloc kidney transplantation from pediatric donor to adult recipients with other transplanted groups, the authors observe similar results between this kind of transplantation and the “optimal” donor group or living kidney donor group, regarding renal function and graft survival, and better results than the transplanted kidneys with expanded criteria donors group. ConclusionsThe results published in the current series lead us to consider this kind of transplant as an option to increase the number of transplants performed.

Estado actual del trasplante renal en bloque de donante pediátrico en receptor adulto joven

Context and objectivesIn recent years, despite the increased number of kidney transplants performed in Spain, we observed a gradual increase in waiting lists. The need to increase the number of transplants performed in our centers, forces us to accept as donors, pacients previously rejected. Acquiring of evidenceWe performed a systematic review using PubMed of published articles in the last 10 years, that include the words trasplante renal en bloque, «en bloc kidney transplantation» or its initials EBKT. Synthesis of evidenceThe pediatric donor to adult recipient has been included in the expanded criteria donors group, being rejected nevethless such donors in most centers. However, in recent published series comparing the en bloc kindey transplantation from pediatric donor to adult recipients with other transplantated groups, the authors observe similar results between this kind of transplantation and the «optimal» donor group or living kidney donor group, regarding renal function and graft survival, and better results than the transplantated kidneys with expanded criteria donors group. ConclusionsThe results published in the current series lead us to consider this kind of transplant as an option to increase the number of transplants performed.

A Single Centre Study of Donation after Cardiac Death Kidney Transplantation - Comparison of Outcomes Between Standard and Expanded Criteria Donor Kidneys

Introduction: Kidneys obtained from donors after cardiac-death (DCD) provide outcomes comparable to those obtained from donors after brain-stem death (DBD). In order to expand the donor pool, more DCD kidneys are being used which were previously considered unacceptable. Here, we compare short-term outcomes within DCD transplants of kidneys from expanded criteria donors (ECD) with those from standard criteria donors (SCD). Methods: From our centre's renal database, we collected data on all controlled (Maastricht 3) DCD kidney transplants from 2004 to 2010. Expanded criteria donor was defined according to UNOS criteria (age ≥ 60 years or 50-59 years with 2 of: hypertension, death from cerebrovascular accident, terminal creatinine ≥ 132 μmol/L). Only conventional cold storage was used. Our protocol included ATG followed by tacrolimus, mycophenolate mofetil and prednisolone. Outcomes studied were 1-year graft and patient survival, delayed graft function (DGF), biopsy-proven acute rejection (BPAR) and 1-year estimated GFR (MDRD). Results: Between 2004 and 2010, 112 DCD transplants were performed from 78 SCD and 34 ECD kidneys. Median follow-up time was 41 months for SCD and 21 months for ECD transplants. Tables 1 and 2 show the donor and recipient characteristics respectively.Table: [Donor Characteristics]Table: [Recipient Characteristics]Warm and cold ischemia times were significantly shorter for ECD kidneys. Incidence of DGF (68% vs.72%, p=0.7), median duration of DGF (4 vs. 6 days, p=0.5) and incidence of BPAR (5% vs. 12%, p=0.18) were similar in SCD and ECD groups respectively. There was 1 case of primary non-function in the SCD group and 2 of early transplant nephrectomy in the ECD group. One-year graft survival (SCD 95% vs. ECD 94%, p=0.8) and patient survival (SCD 96% vs. ECD 100%, p=0.2) were similar. Median eGFR at 6 months (50 vs. 40 ml/min, p=0.004) and 1 year (53 vs. 41 ml/min, p=0.003) was lower in the ECD group. Conclusion: The proportion of ECD kidneys is increasing within the DCD cohort. One-year graft survival from ECD kidneys is comparable to that obtained from SCD kidneys when cold ischemia time is short, although the one-year allograft function is inferior. These findings warrant further follow-up to determine long-term outcomes from cardiac-death donor ECD kidneys.

Cardiovascular Risk in Recipients With Kidney Transplants From Expanded Criteria Donors

IntroductionPosttransplant cardiovascular disease (CVD) is the leading cause of death in renal transplant (RT) recipients and is more evident in recipients with transplants from expanded criteria donors (ECD). ObjectiesWe analyzed the evolution of cardiovascular risk factors and their association with patient mortality. Materials and methodsWe undertook a single-center, prospective study of RT patients (n = 360) between 1999 and 2006. These were 180 recipients with transplants from ECD and 180 controls. We analyzed the baseline characteristics and the cardiovascular risk factors: hypertension, diabetes, dyslipidemia, CVD, and anemia. Posttransplant analyses included the evolution of cardiovascular risk factors and causes of death. ResultsThe mean age of the ECD was 63.5 ± 5.4 versus 32.0 ± 13.2 years in the non-ECD (P < .001) and the recipient ages were 58.4 ± 8.7 versus 40.8 ± 13.3 years, respectively (P < .001). The median interquartile range [IQR] dialysis time was 25 months (15–39) versus 20 months (12–44; P = .017). The pretransplant body mass index was 26.89 ± 3.91 versus 25.43 ± 4.72 kg/m2 (P = .002); the median (IQR) number of antihypertensive drugs was two (1–2) versus two (1–2.75; P = .015); dyslipidemia was present in 32.5% versus 21.6% (P = .024), diabetes in 10.6% versus 5.6% (P = .087), and CVD in 13.3% versus 7.8% (P = .086). Treatment with erythropoiesis-stimulating agents (ESA) was received by 84.9% versus 83.9% (P = .857). Concerning transplantation, the mean follow-up was 64.3 ± 33.7 months. Hypertension was present at 3 and 5 years in 85.6% versus 69.5% (P = .001) and 87.9% versus 72.8% (P = .009), respiratory. Treatment with angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers at 3 and 5 years was 79.8% versus 64.5% and 85.6% versus 65%. Dyslipidemia was present at 5 years in 63.1% versus 58.0% (P = .482). De novo diabetes occurred in 16.7% versus 11.1% (P = .128), and CVD in 13.5% versus 4.5% (P = .003). Univariate and multivariate Cox regression proportional hazards models were constructed to analyze the factors associated with patient death. ConclusionsCVD is the most common cause of death in recipients of ECD, RT, 40% in the ECD group versus 28.6% in the control group. Tight control of cardiovascular risk factors and a good pretransplant patient selection contributed to the good results obtained.