Outcome of expanded criteria donor kidneys that were transplanted at other Eurotransplant centers after being rejected by our institution

Abstract

Based on our findings, we propose that acceptance criteria for marginal donor kidneys need to be widened.

Editorial for a special issue on kidney transplant

“…Despite these controversial debates, there is no doubt that kidney transplant centers have to become more and more familiar with the aging of the population, and therefore, the tolerance to accept kidneys coming from sub-optimal donors has to increase. Friedersdorff et al [4] have reported their experience reviewing 110 kidneys that were primarily rejected in their institution and then transplanted at other Eurotransplant centers. The cold ischemia time average was 16 h.…”

Poor organ quality and donor-recipient age mismatch rather than poor donation rates account for the decrease in deceased kidney transplantation rates in a Germany Transplant Center

“…One year after transplantation creatinine had fallen to 1.6 ± 0.8 mg/dl in patients transplanted elsewhere, which was not significantly different from the best creatinine of the kidneys transplanted in Freiburg (1.6 ± 0.9 mg/dl, NS). The same results could be shown by Friedersdorff et al ., who described that in 31% of patients rejected in Berlin and transplanted elsewhere, creatinine values were below 1.47% and 94% under 2.97 mg/dl .…”

“…The decision whether to accept an organ or not is made predominantly by the transplant surgeon on the basis of a risk‐benefit assessment and is also practiced at our center. Individual preferences of patients are currently less respected , although it is regarded as an essential component of patient care to allow patient participation in medical decisions.…”

“…The final decision whether or not to accept a kidney is predominantly made by transplant surgeons , based on the anticipated cold ischemia time (CIT), age‐ and weight‐matching, and cause of brain death . Although recipients of extended criteria donor (ECD) kidneys have a 77% higher risk of graft failure than patients receiving a conventional transplant , marginal kidneys doubled the deceased transplant volume between 2005 and 2011 .…”

Marginal Donors in Renal Transplantation

“…For example, a recent singlecenter study comparing renal transplantations from 30 living marginal donors (age over 60 years, with hypertension, with renal cysts, with ovarian cysts, with hysteromyoma, with renal calculus, with renal artery stenosis, or with myasthenia gravis) with 58 non-marginal living kidney transplantations reported 3-year graft survival as 96.7% and 100%, respectively [13]. One hundred ten deceased marginal kidney donations rejected by a transplantation center were transplanted to ESRD recipients in other facilities, and positive results with respect to graft and recipient survival (6 and 7 years, respectively) were reported [14]. Barba et al [15], on the other hand, studied 407 renal transplants from deceased donors with respect to longterm graft survival and reported 26% graft failure for kidney transplants from marginal donors versus 10% for standard criteria kidney donations.…”