Renal Transplantation With Expanded Criteria Donors: The Experience of One Portuguese Center

Abstract

Background. The shortage of kidneys available for transplantation has led to enlarged criteria donors (ECD): namely, donors older than 60 years or aged between 50 and 59 years with 2 of the following characteristics-hypertension, predonation serum creatinine level higher than 1.5 mg/dL or cerebrovascular disease as the cause of death. The aim of this study was to analyze renal transplants using ECD compared with standard criteria donors (SCD) concerning the incidences of delayed graft function (DGF), acute rejection episodes (ARE), and patient and graft survivals. Materials and Methods. This retrospective study of 409 cadaveric renal transplants over the last 4 years identified ECD in contrast with SCD. Results. Of the transplants, 24.4% used ECD. The baseline characteristics of recipients of ECD versus SCD kidneys were similar, except for age and cold ischemia time.Comparing ECD and SCD, we observed an higher incidence of DGF (35% vs 18%), occurrence of ARE (34.4% vs 16.6%), average serum creatinine levels at 6 (1.87 vs 1.4 mg/dL), and 12 months (1.88 vs 1.43 mg/dL) as well as lower graft survival at 1 (82% vs 91%) and 3 years (75% vs 84%) after transplantation. Recipient survival at 1 year was not different. Multivariate analysis identified recipient age, cold ischemia time, ARE, and DGF as risk factors for graft failure. Conclusions. Renal transplantation with grafts from ECD shows significantly worse outcomes with higher rates of DGF and ARE, worse graft function, and lower graft survival.

Deceased donor neutrophil gelatinase-associated lipocalin and delayed graft function after kidney transplantation: a prospective study

“…There is no consensus on the ultimate effect of short DGF, lasting less than one week, on graft survival; however, when the duration of allograft dysfunction becomes prolonged, the negative effect on kidney graft survival becomes evident [1,2]. The criteria for deceased donors have been expanded because of organ shortages, and consequently DGF has become more common [3,4]. At our center, we have expanded our criteria for acceptable kidney donors since 1995.…”

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

“…The risk of graft failure (e.g., return to maintenance dialysis or graft nephrectomy) is more frequent in marginal donor kidney recipients [6,16,17], as largely documented in recently published series [20][21][22][23][24][25][26][27] (Table 1). Aging of the donors directly impacts on long-term graft survival, and, in a recent series, among 407 KTs, graft survival was significantly lower for the ECD when compared to the non-ECD (5-year survival rate: 74% versus 90%, < 0.001) [21]; the older the donor, the greater seems to be the decrease in survival [6].…”

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“…[5][6][7][8][9][10][11] However, kidneys from very young donors are also associated with poor outcome, likely related to technical complications and graft thrombosis. 12 Furthermore, studies have shown that patient survival at the end of the first and third year after transplant were comparable between expanded criteria donors and standard criteria donors [13][14][15] ; however, graft survival and function were significantly worse with increased incidence of delayed graft function (DGF) and acute rejection episodes. 15 Ferrer and associates identified DGF and acute rejection episodes as risk factors for graft failure.…”

“…12 Furthermore, studies have shown that patient survival at the end of the first and third year after transplant were comparable between expanded criteria donors and standard criteria donors [13][14][15] ; however, graft survival and function were significantly worse with increased incidence of delayed graft function (DGF) and acute rejection episodes. 15 Ferrer and associates identified DGF and acute rejection episodes as risk factors for graft failure. 15 In addition, there are reports concluding that there is no statistical significant correlation between donor age and 5-year graft function.…”

“…15 Ferrer and associates identified DGF and acute rejection episodes as risk factors for graft failure. 15 In addition, there are reports concluding that there is no statistical significant correlation between donor age and 5-year graft function. 16 Therefore, donors who were previously considered as not ideal are now considered to be suitable.…”