title: Survival after kidney transplantation does not differ with 50-59- or over 60-year-old expanded-criteria donors.
abstract: BACKGROUND
  Use of expanded-criteria donors (ECDs) for kidney transplantation has progressively increased in the past years with the intent to improve the number of available grafts. However, it is still uncertain if ECD kidneys have worse survivals than standard-criteria ones. The aim of this study was to retrospectively analyze a cohort of ECD patients comparing the 2 subgroups of 50-59- and >60-year-old donors in terms of donor, recipient, and transplant features and survival rates.
  
  
  METHODS
  Ninety-one cases were analyzed. The cohort was stratified into 2 subgroups according to donor age: group 1, age 50-59 years (n=26); and group 2, age ≥60 years (n=67).
  
  
  RESULTS
  Group 2 represented older donors and a higher percentage of donors with a previous history of hypertension. In Group 1, preharvest creatinine values showed higher results. No difference was detected regarding patient and graft survivals, with 5-year survival rates of 92.3% versus 86.7%, and 70.8% versus 69.8%, respectively. The best way to select the donors is still under debate. In our experience, a biopsy-driven selection was performed exclusively for group 2 ECDs. Considering the similar survivals obtained, we speculated that an accurate biopsy-based selection of older grafts allows one to avoid "bad" donors from the allocation system, thereby obtaining improved survival results.
  
  
  CONCLUSIONS
  Biopsy-driven pretransplantation selection appears to be the main system to optimize results, to achieve outcomes similar to nonbiopsied younger donors. Routine biopsies also in the younger subgroup of ECD may achieve a further improvement in survival.
authors.affiliation: Department of General Surgery and Organ Transplantation, Sapienza University, Umberto I Hospital, Rome, Italy. lai.quirino@libero.it
authors.forename: Q
authors.initials: Q
authors.lastname: Lai
authors.forename: F
authors.initials: F
authors.lastname: Nudo
authors.forename: G B
authors.initials: GB
authors.lastname: Levi Sandri
authors.forename: F
authors.initials: F
authors.lastname: Melandro
authors.forename: S
authors.initials: S
authors.lastname: Ferretti
authors.forename: M
authors.initials: M
authors.lastname: Grieco
authors.forename: M
authors.initials: M
authors.lastname: Garofalo
authors.forename: L
authors.initials: L
authors.lastname: Poli
authors.forename: R
authors.initials: R
authors.lastname: Pretagostini
authors.forename: P B
authors.initials: PB
authors.lastname: Berloco
mesh_terms: D000328:Adult; D000367:Age Factors; D001706:Biopsy; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006305:Health Status Indicators; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome