Spanish consensus document for acceptance and rejection of kidneys from expanded criteria donors

Abstract

In the recent years, more than 60% of available deceased donors are either older than 50 yr or have significant vascular comorbidities. This makes the acceptance and rejection criteria of renal allografts very rigorous, especially in cases of younger recipients, and at the same time encourages live donations. In our country, there is a lack of homogeneity in the percentages of use of expanded criteria donor (ECD) allografts between the different autonomous communities. Furthermore, the criteria vary greatly, and in some cases, great importance is given to the biopsy while in others very little. In this study, we present a unified and homogenous criteria agreed upon by consensus of a 10-member Panel representing major scientific societies related to renal transplantation in Spain. The criteria are to be used in accepting and/or rejecting kidneys from the so-called ECDs. The goal was to standardize the use of these organs, to optimize the results, and most importantly to provide for the maximum well being of our patients. Finally, we believe that after taking into account the Panel's thorough review of specific scientific literature, this document will be adaptable to other national renal transplant programmes.

Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study

“…Although circulating DSA are known to impair allograft outcomes, their specific effect, the amplitude of their effect, and their independency from other relevant predictors have not been specifically analysed in the recipients of ECD transplants. 18 26 27 28 29 The structure of the existing registries—the United Network of Organ Sharing in the USA, 30 Eurotransplant, 31 32 the Organ Procurement Agency in Spain, 33 and the French National Agency for Organ Procurement 17 —does not specifically integrate the whole spectrum of important determinants that might affect ECD prognosis.…”

Survival Benefit From Kidney Transplantation Using Kidneys From Deceased Donors Aged ≥75 Years: A Time-Dependent Analysis

“…In parallel, donor age is also increasing . Historically, kidneys from older donors were usually discarded, but the constant improvement in organ procurement and assessment has permitted us to expand donor acceptance criteria, demonstrating that age itself should not be a limiting parameter . In fact, although patient and graft survival is lower with kidneys from older donors, patient survival rates seem to be higher compared with those remaining on dialysis .…”

Caracterización de trasplantados renales con donantes de criterios expandidos

“…Resultados clínicos de los receptores con DCE. como tiempo en lista prolongado y considerarse en menores de 55 años que son hiperinmunizados (25). Si bien, existen revisiones sistemáticas que encuentran que los pacientes menores de 40 años no se benefician de recibir DCE, debe realizarse una aproximación individualizada (3).…”