title: Expanded criteria donor kidneys for younger recipients: acceptable outcomes.
abstract: BACKGROUND
  European senior programme (ESP) is well known for acceptable outcomes using expanded criteria donor (ECD) kidneys from donors older than 65 years for recipients older than 65 years. The incidence of end-stage renal disease (ESRD) is 229/million in India with a mean age of 45 years. We performed a retrospective analysis of transplantation of ECD versus standard criteria donor (SCD) kidneys into younger recipients.
  
  
  METHODS
  Forty-three ECD transplantations among 158 deceased donor organ transplantation (DDOT) were performed between January 2006 and December 2009. Among 43 transplantation from 30 donors, 14 were dual kidney transplantations (DKT) performed based upon biopsy evaluation. All recipients received thymoglobulin (rATG) induction followed by immunosuppression with a steroid, mycophenolate mofetil (MMF), and a calcineurin inhibitor. Statistical analysis used chi-square test and unpaired Student t test. Kaplan-Meier curves were used for survival analysis.
  
  
  RESULTS
  For ECD the mean donor age was 64 ± 11 years. Cerebrovascular accidents (CVA) were the cause of death among 60% of donors, 73.13% of whom were hypertensive and 23.13% diabetic. Mean DKT donor age was 75 ± 9.17 years versus 60 ± 8.0 years for single kidney transplantation (SKT). Mean recipient age of DKT versus SKT was 44 ± 12.4 years versus 43 ± 14 years. Mean serum creatinine (SCr; mg/dL) of SKT patients was 1.64 ± 0.75 versus 1.68 ± 0.46 in DKT. Mean follow-up was 455 ± 352 days. Mean SCr of 43 ECD recipients of mean age, 43.4 ± 14.2 years was 1.61 ± 0.61 mg/dL. Among 43 recipients, 23.25% were diabetic, 41.86% displayed delayed graft function (DGF), and 23.25% experienced biopsy-proven acute rejection (BPAR). Patient survival rate was 72.09% and graft survival rate was 67.44%. For SCD transplantations (n = 115), the mean donor age was 36 ± 14 years and recipient mean age was 32.8 ± 14.07 years. Mean SCr was 1.32 ± 0.46 mg/dL with 26.95% recipients displaying DGF, whereas 20.86% had BPAR. In the SCD group the patient survival rate was 79.13% and the graft survival rate was 72.17%. Thus, although the ECD group showed poor graft function (P = .042), they had acceptable patient and graft survivals (P = .34 and P = .56, respectively).
  
  
  CONCLUSIONS
  Because of the organ shortage, DDOT using ECD transplants for younger recipients is a feasible option with acceptable outcomes.
authors.affiliation: Department of Nephrology IKDRC ITS, Ahmedabad, Gujarat, India. kamalgoplani@gmail.com
authors.forename: K R
authors.initials: KR
authors.lastname: Goplani
authors.forename: V B
authors.initials: VB
authors.lastname: Kute
authors.forename: A V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: P R
authors.initials: PR
authors.lastname: Shah
authors.forename: M R
authors.initials: MR
authors.lastname: Gumber
authors.forename: H V
authors.initials: HV
authors.lastname: Patel
authors.forename: P R
authors.initials: PR
authors.lastname: Modi
authors.forename: H L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005060:Europe; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors
chemical_list: D003404:Creatinine