Deceased donor organ transplantation with expanded criteria donors: a single-center experience from India.
BACKGROUND
Deceased donor organ transplantation (DDOT) accounts for <4% of renal transplants in India. Many volunteers come forth for organ donation with increasing awareness; unfortunately, the majority are marginal donors, but their rejection would hamper the DDOT program. Judicious use of marginal organs is a challenge for developing countries.


METHODS
We performed 29 renal transplants from 21 expanded criteria donors (ECD) out of 115 DDOT between January 2006 to April 2009-10 dual (DKT) and 19 single (SKT). Fourteen donors had hypertension, a cerebrovascular accident as the cause of death, 9 had both, and 4 had diabetes. Mean donor age was 70.3 +/- 8.9 years. Decisions on the procedure were based upon frozen section biopsy in 13 of 21 donors. Mean DKT donor age was 76 +/- 9.7 years versu 64 +/- 5.7 years of SKT donors. The native kidney diseases were chronic glomerulonephritis (n = 14), diabetic nephropathy (n = 7), tubulointerstitial nephritis (n = 4) and polycystic kidney disease, focal segmental glomerulosclerosis, lupus nephritis and patchy cortical necrosis, (n = 1 each). Mean recipient age of DKT versus SKT was 43.5 versus 42.3 years. All recipients received rabbit anti-thymocyte globulin, followed by steroid, mycophenolate mofetil/calcinueurin inhibitor.


RESULTS
Over a mean follow-up of 341 days, the mean serum creatinine (SCr) of 25/29 patients was 1.60 mg/dL (range, 1.0-2.6). The mean SCr of SKT patients was 1.59 +/- 0.63 mg/dL and of DKT, 1.62 +/- 0.48 mg/dL. Ten patients had delayed graft function and 11 had biopsy proven acute tubular necrosis. Seven (24%) patients had rejection (grade 3 Banff update '05, type IA; 4, type 2A); 6 responded to antirejection; 1 graft was lost at 7 months due to chronic rejection. Three (10.3%) patients were lost, 1 each due to AMI, sepsis, and CMV disease.


CONCLUSIONS
In the circumstances of organ shortage, DDOT with expanded criteria donor is a feasible option.
Goplani
K R
KR
Department of Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, India. kamalgoplani@gmail.com
Firoz
A
A
Ramakrishana
P
P
Shah
P R
PR
Gumber
M R
MR
Patel
H V
HV
Vanikar
A V
AV
Trivedi
H L
HL
D000328:Adult; D000368:Aged; D002102:Cadaver; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*
D007166:Immunosuppressive Agents; D003404:Creatinine