Prediction of Three-Year Outcome of Renal Transplantation from Optimal Donors versus Expanded Criteria Donors

Abstract

Background/Aims: The shortage in organ supply has required the use of expanded criteria donors (ECD) for kidney transplantation. Current pre-transplant evaluations of ECD organs are based on histological, clinical or mixed criteria. This monocentric study investigates the predictivity of Karpinski’s histological score on 3-year graft function in renal transplant. Ex-post classification using Nyberg’s score was carried out to assess the reliability of a purely clinical score and its applicability for organ allocation. Methods: We evaluated 407 deceased donors (251 optimal and 156 ECD) for renal transplants performed between 2001 and 2006. The differences in creatinine levels and MDRD-GFR at transplant and 1, 2 and 3 years post-transplant between optimal donors and ECD were recorded. Amongst ECD organs, the effect of different Karpinski score classes (0–1, 2, 3, 4, double transplants) on 3-year graft outcomes was analyzed. We then compared renal function over time across the Nyberg grades (A, B, C, and D). Results: Karpinski scores 0–1 and 2 and double transplants were associated with improved graft function compared to scores 3 and 4. Nyberg’s clinical score shows a good fit with medium-term outcome and Karpinski’s score, but among the donors with a high Nyberg grade (C and D), it fails to differentiate between allocable or non-allocable organs (due to Karpinski’s score ≥7). Conclusions: Our data demonstrate a correlation of histological damage at the time of transplant with 3-year graft function, but at present we are unable to provide any supposition on the possible outcome of the discarded kidneys.

The Need for New Donor Stratification to Predict Graft Survival in Deceased Donor Kidney Transplantation

“…In addition, the incidence of DGF and acute rejection at 1 year posttransplant were not inferior in ECD recipients. These results are in agreement with those of other studies 1415…”

Dual Kidney Transplantation after Hypothermic Oxygenated Perfusion from Marginal Donor after Circulatory Death with Acute Kidney Injury: A Case Report

“…The prospect of transplanting both kidneys from a high-risk donor, DKT, is a successful approach for optimizing the donor kidney pool [36]. The selection of kidneys for transplantation (SKT or DKT) includes donor data like age, donor history, renal function, macroscopic aspect and histological findings in kidney biopsy [1,13,[36][37][38][39].…”

A Retrospective Cohort Study on Rehospitalization following Expanded Criteria Donor Kidney Transplantation

“…Studies have argued for decreased cold ischemia time, using perfusion pumps rather than simple cold storage, selective use of ECDs for recipients with low PRA, or refinement of predictors for graft failure through kidney biopsy [33–39]. Some of these studies report promising results using combinations of all of these techniques [40]. More recently, there has been progress diagnosing acute rejection through use of ultrasound or urine metabolites, which may improve the longevity of the allograft [39, 41].…”

“…Additionally, newer studies have suggested that kidney biopsy may be a more effective way of predicting graft longevity [45]. There has been an attempt to standardize the biopsy-reading process with specialized pathologists and scoring systems [40,46–48]. These scoring systems may supplement the predictive power of the KDPI.…”