Comparison of expanded criteria kidneys with 2-tier standard criteria kidneys: role of delayed graft function in short-term graft outcome.
OBJECTIVE
To compare transplant outcomes between expanded criteria donor kidneys and standard criteria donor kidneys.


METHODS
All adult renal transplants from deceased donors performed in Saudi Arabia over a 24-month period were included. Donor and recipient factors were recorded, and their effects on outcomes with expanded criteria donor and standard criteria donor kidneys were compared. Standard criteria donor kidneys were further subgrouped into optimal and suboptimal groups, and outcomes were compared.


RESULTS
A total of 280 deceased-donor kidney transplants were performed during the study period. Of these, 61 (21.8%) involved expanded criteria donor kidneys. Cold ischemia time and prevalence of delayed graft function were similar between expanded criteria and standard criteria kidneys (P = .7 and P = .8). Graft survival rates at 2 years were also similar (93.3% vs 94.6%; P = .8). Delayed graft function exerted a negative effect on 2-year graft survival in both the expanded group (hazard ratio, 4.9; 95% CI 3.2-7.5; P = .001) and the standard group (hazard ratio, 4.6; 95% CI 3.24-7.5; P = .001). No difference was found between the 2 standard criteria subgroups with respect to serum creatinine value at the end of follow-up (P = .8), delayed graft function prevalence (P =.5), or 2-year graft survival (P = .8). The only independent factor affecting graft survival was delayed graft function (P = .001). No independent effect was seen for expanded criteria donor versus standard criteria donor, donor serum creatinine level, or recipient age.


CONCLUSIONS
Similar short-term outcomes were found for expanded criteria and standard criteria kidney recipients. Delayed graft function was associated with significant risk of graft loss in both groups, with decreases in 2-year graft survival of 33.3% and 18.3%. No difference was seen between the 2 subtypes of standard criteria donor kidneys.
Saudi Centre for Organ Transplantation, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Faissal Abdulraheem
FA
Shaheen
Besher
B
Attar
Fayez
F
Hejaili
Saleh
S
Binsalih
Abdulla
A
Al Sayyari
D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000453:epidemiology* / Q000503:physiopathology*; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007668:Kidney; D016030:Kidney Transplantation / Q000502:physiology*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012529:Saudi Arabia; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*
D003404:Creatinine