Renal transplantation with expanded criteria donors: the experience of one Portuguese center.
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.


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.
Renal Transplantation Unit, Department of Urology and Renal Transplantation, Hospitais da Universidade de Coimbra, Portugal. franciscodina@gmail.com
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D002102:Cadaver; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008875:Middle Aged; D018579:Patient Selection; D011174:Portugal; D051437:Renal Insufficiency / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D014019:Tissue Donors / Q000706:statistics & numerical data*
D003404:Creatinine