Use of marginal organs in kidney transplantation for marginal recipients: too close to the margins of safety?
OBJECTIVE
Due to organ shortage, average waiting time for a kidney in Germany is about 4 years after start of dialysis. Number of kidney grafts recovered can only be maintained by accepting older and expanded criteria donors. The aim of this study was to analyse the impact of donor and recipient risk on kidney long-term function.


METHODS
All deceased kidney transplantations were considered. We retrospectively studied 332 patients between 2002 and 2006; divided in 4 groups reflecting donor and recipient risk.


RESULTS
Non-marginal recipients were less likely to receive a marginal organ (69 of 207, 33%) as compared to marginal recipients, of whom two-thirds received a marginal organ (p<0.0001). Graft function significantly differed between the groups, but detrimental effect of marginal recipient status on eGFR after 12 months (-6 ml/min/1.73qm, 95% CI -2 to -9) was clearly smaller than the effect of marginal donor status (-10 ml/min/1.73qm, 95% CI -7 to -14).


CONCLUSIONS
As we were able to show expanded criteria donor has a far bigger effect on long-term graft function than the "extra risk" recipient. Although there have been attempts to define groups of recipients who should be offered ECD kidneys primarily the discussion is still ongoing.
Department of General-, Visceral- and Transplantation Surgery, University Hospital of Essen, 45122 Essen, Germany.
M
M
Heuer
A
A
Zeiger
G M
GM
Kaiser
Z
Z
Mathé
A
A
Goldenberg
S
S
Sauerland
A
A
Paul
Jürgen W
JW
Treckmann
D000328:Adult; D017677:Age Distribution; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006648:Histocompatibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality* / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*