Renal transplantation in old recipients from expanded criteria donors selected by kidney biopsy.
BACKGROUND
In Spain, the number of ideal kidney transplant donors has fallen, with at the same time an increase in the number of older recipients on the waiting list.


OBJECTIVE
To analyze the results of expanded criteria cadaveric donor kidney transplants into older recipients using grafts selected by kidney biopsy.


METHODS
We studied 360 kidney transplant recipients who had been followed to December 2009: 180 in the study group and 180 in a control group composed of younger patients who received grafts from non-expanded criteria donors between 1999 and 2006. A paraffin-embedded kidney biopsy was evaluated by the percentages of sclerosed glomeruli, arteriolar hyalinosis, intimal wall thickening, interstitial fibrosis, and tubular atrophy.


RESULTS
Significant differences were observed in donor age (63.50±5.46 vs 31.90±13.29 years; P<.001) and recipient age (58.40±8.80 vs 40.71±13.23 years; P<.001). Donor renal function was significantly worse among the expanded criteria group (90.80 vs 108.11 mL/min/1.73 m2; P=.006), remaining so over time in the recipient (at 1 year: 42.08 vs 63.71 [P<.001]; at 3 years: 41.25 vs 62.31 [P<.001], and at 7 years: 38.17 vs 64.18 [P<.001]). Censored 7-year graft survivals were 73% versus 87% (P<.001) with similar patient survivals (90.5% vs 95%; P=.39).


CONCLUSIONS
Selection of expanded criteria donors by kidney biopsy resulted in good renal function as well as graft and patient survivals at 7 years in older recipients.
Nephrology Department, Carlos Haya University Hospital, Malaga, Spain.
M
M
Cabello
C
C
Cobelo
M
M
Gonzalez-Molina
G
G
Leon
I
I
Garcia
E
E
Gutierrez
E
E
Sola
V
V
Lopez
C
C
Gutierrez
D
D
Burgos
D
D
Hernandez
D000328:Adult; D000368:Aged; D001706:Biopsy; D003401:Creatine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors
D007166:Immunosuppressive Agents; D003401:Creatine