title: Expanded criteria donors, histological scoring, and prolonged cold ischemia: impact on renal graft survival.
abstract: The use of expanded donors or kidneys with preexistent chronic damage remains controversial, but they offer the opportunity to expand the donor pool. We investigated the impact of these conditions as predictors of graft survival among a cohort of recipients with prolonged cold ischemia times and a high incidence of delayed graft function. We included 70 consecutive cadaveric kidney allografts implanted between 2001 and 2005, which had undergone an early graft biopsy. Delayed graft function was present in 84% of cases with moderate or severe preexistent chronic damage in 63% and 27% of biopsies, respectively, and acute rejection was diagnosed in 14.3% of overall cases. The graft survival was 73.3% at 48 months. Primary nonfunctioning kidneys were more frequent using kidneys from expanded compared with standard donors (20.0% vs 0.0%, P < .002). Multivariate analysis showed that only the donor condition (standard vs expanded) was independently associated with graft survival (hazard ratio: 0.12; 95% confidence interval: 0.01-0.87; P < .03). Our results suggested that the donor characteristics prevail over other variables to predict graft outcomes.
authors.affiliation: Renal Transplant Program, Hospital Privado Centro-Médico de Córdoba, Córdoba, Argentina. cchiurchiu@hospitalprivadosa.com.ar
authors.forename: C
authors.initials: C
authors.lastname: Chiurchiu
authors.forename: V
authors.initials: V
authors.lastname: Riva
authors.forename: M V
authors.initials: MV
authors.lastname: Bürgesser
authors.forename: J
authors.initials: J
authors.lastname: de Arteaga
authors.forename: W
authors.initials: W
authors.lastname: Douthat
authors.forename: J
authors.initials: J
authors.lastname: de la Fuente
authors.forename: A B
authors.initials: AB
authors.lastname: de Diller
authors.forename: P U
authors.initials: PU
authors.lastname: Massari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D050377:Cold Ischemia; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D016030:Kidney Transplantation / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D051437:Renal Insufficiency / Q000401:mortality*; D015427:Reperfusion Injury / Q000473:pathology*; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards; D016896:Treatment Outcome