Acceptable outcome after kidney transplantation using "expanded criteria donor" grafts.
BACKGROUND
With the worldwide shortage of donors, extra lengths are ongoing to enlarge the donor pool. One means has been a greater use of "expanded criteria donor" (ECD) grafts. A major concern regarding ECD kidneys is poor long-term graft survival. The aims of this study were to determine whether ECD grafts, as defined by the United Network for Organ Sharing, had a negative impact on graft survival and to identify the principle donor and recipient factors that influenced graft survival in our patient cohort.


METHODS
We analyzed all deceased donor renal transplants in our unit from January 1995 to October 2005, in total 1,053 transplants.


RESULTS
ECD grafts (United Network for Organ Sharing criteria) demonstrated higher rates of delayed graft function and higher early mean creatinine levels. However, there was no significant difference in 5-year graft survival. Multivariate analysis of our patient group identified donor hypertension and ischemic heart disease (IHD) as independent predictors of poor graft survival. Recipient age was significant on univariate but not on multivariate analysis. However, although younger recipients maintained acceptable 5-year graft survival despite donor hypertension, IHD, or a combination of both, these factors significantly reduced graft survival in older recipients.


CONCLUSIONS
Although ECD grafts had slightly worse function, 5-year survival was comparable with standard grafts in all recipients. Donor hypertension, IHD, or a combination of both significantly reduced graft survival in older recipients, not evident in younger patients. We discuss the possible factors for improved outcome with ECD grafts in our patients and the implications of our patient analysis.
Fraser
Sheila M
SM
Division of Transplant Surgery, Department of Surgery, St. James's University Hospital, Leeds, United Kingdom.
Rajasundaram
Rajaganeshan
R
Aldouri
Amer
A
Farid
Shahid
S
Morris-Stiff
Gareth
G
Baker
Richard
R
Newstead
Charles G
CG
Toogood
Giles J
GJ
Menon
Krishna V
KV
Ahmad
Niaz
N
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002102:Cadaver; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D015993:Life Tables; D019520:Living Donors / Q000706:statistics & numerical data; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom