title: Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant.
abstract: OBJECTIVE
  To compare outcomes in recipients of expanded criteria donor (ECD) versus standard criteria donor (SCD) kidneys at a single center using a standardized approach with similar immunosuppression.
  
  
  BACKGROUND
  Expanded criteria deceased organ donors (ECD) are a source of kidneys that permit more patients to benefit from transplantation. ECD is defined as all deceased donors older than 60 years and donors older than 50 years with 2 of the following: hypertension, stroke as the cause of death, or pre-retrieval serum creatinine (SCr) greater than 1.5 mg/dl.
  
  
  METHODS
  We retrospectively studied 90 recipients of adult deceased donor kidneys transplanted from October 1, 2001 to February 17, 2003, including 37 (41%) from ECDs and 53 (59%) from SCDs. ECD kidneys were used by matching estimated renal functional mass to recipient need, including the use of dual kidney transplants (n = 7). ECD kidney recipients were further selected on the basis of older age, HLA-matching, low allosensitization, and low body mass index. All patients received a similar immunosuppressive regimen. Minimum follow up was 9 months.
  
  
  RESULTS
  There were significant differences in donor and recipient characteristics between ECD and SCD transplants. Patient (99%) and kidney graft survival (88%) rates and morbidity were similar between the 2 groups, with a mean follow-up of 16 months. Initial graft function and the mean 1-week and 1-, 3-, 6-, 12-, and 18-month SCr levels were similar among groups.
  
  
  CONCLUSIONS
  The use of ECD kidneys at our center effectively doubled our transplant volume within 1 year. A systematic approach to ECD kidneys based on nephron mass matching and nephron sparing measures may provide optimal utilization with short-term outcomes and renal function comparable to SCD kidneys.
authors.affiliation: Department of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA. rstratta@wfubmc.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rohr
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Sundberg
authors.forename: Greg
authors.initials: G
authors.lastname: Armstrong
authors.forename: Gloria
authors.initials: G
authors.lastname: Hairston
authors.forename: Erica
authors.initials: E
authors.lastname: Hartmann
authors.forename: Alan C
authors.initials: AC
authors.lastname: Farney
authors.forename: Julie
authors.initials: J
authors.lastname: Roskopf
authors.forename: Samy S
authors.initials: SS
authors.lastname: Iskandar
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Adams
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine