title: Expanded-criteria donor kidneys: a single-center clinical and short-term financial analysis--cause for concern in retransplantation.
abstract: BACKGROUND
  Expanded-criteria donor (ECD) kidneys are associated with a higher risk of posttransplant failure, but they remain a favorable alternative to dialysis. Now that a uniform definition of "expanded criteria" exists, it is more appropriate than ever to evaluate their utility compared with that seen with non-ECD kidneys.
  
  
  METHODS
  The authors analyzed 202 cadaveric kidney-only recipients that underwent transplantation from January 1999 to September 2001, including 45 (22%) recipients whose donors met current ECD criteria.
  
  
  RESULTS
  ECD and non-ECD kidney recipients had similar pretransplant characteristics except for older age and increased duration of renal failure in the ECD group. Patient, graft, and death-censored graft survival in both groups were similar in primary recipients but significantly worse in retransplant recipients of ECD kidneys. The relative risk of death-censored graft loss was 1.58 in the ECD group (P = 0.45). Overall inpatient charges (minus organ acquisition charge) for 1 year posttransplant were 76,962 US dollars (ECD) versus 71,026 US dollars (non-ECD) (P = 0.53); the same charges in retransplant recipients were 136,596 US dollars (ECD) versus 91,296 US dollars (non-ECD) (P = 0.25). ECD recipients, especially retransplant recipients, had consistently higher creatinine concentrations, although the average current value of all functioning ECD grafts remains less than 2 mg/dL. ECD recipients had a higher incidence of ureteral stricture (4.4% vs. 0%), but this never resulted in graft loss.
  
  
  CONCLUSIONS
  Considering the widening disparity between renal allograft availability and need and the fact that ECD kidneys provide superior outcomes compared with dialysis, the authors' data encourage the continued use of ECD kidneys in primary recipients but justify caution in the retransplant setting.
authors.affiliation: Department of Surgery (Transplantation), University of Pennsylvania, Philadelphia, PA 19104, USA. marty.sellers@uphs.upenn.edu
authors.forename: Marty T
authors.initials: MT
authors.lastname: Sellers
authors.forename: Ergun
authors.initials: E
authors.lastname: Velidedeoglu
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Robert A
authors.initials: RA
authors.lastname: Grossman
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Markmann
authors.forename: Ali
authors.initials: A
authors.lastname: Naji
authors.forename: Adam M
authors.initials: AM
authors.lastname: Frank
authors.forename: Allyson B
authors.initials: AB
authors.lastname: Kass
authors.forename: Howard M
authors.initials: HM
authors.lastname: Nathan
authors.forename: Richard D
authors.initials: RD
authors.lastname: Hasz
authors.forename: John D
authors.initials: JD
authors.lastname: Abrams
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation
chemical_list: D003404:Creatinine