Kidney transplantation using expanded criteria donors in Korea.
BACKGROUND
Use of expanded criteria donor (ECD) grafts seeks to solve the organ shortage. We investigated the current status of donor selection and transplantation outcomes.


METHODS
We retrospectively analyzed 791 kidney transplantations performed between 1997 and 2009. An expanded criteria deceased donor (ECDD) was defined as an individual who fulfilled the United Network for Organ Sharing criteria or, the Nyberg criteria. An expanded criteria living donor (ECLD) was determined by fulfillment of 1 or more of 5 criteria.


RESULTS
Deceased and living donor kidney transplantations were performed in 228 (28.8%) and 563 (71.2%) cases, respectively. Forty-three cases (18.9%) belonged to the ECDDs. The ECDD group showed a lower posttransplantation 1-year estimated glomerular filtration rate (eGFR) than that of the standard criteria deceased donor (SCDD) group (70.7 ± 19.2 vs 48.6 ± 11.5; P < .001). The ECDDs were allocated to older recipients or recipients with more HLA mismatches than SCDDs. The number of ECLD cases was 173 (30.7%). The proportions of each medical abnormality of living donors were as follows: age older than 60 years (0.5%), hypertension (2.5%), obesity (2.1%), low eGFR (25.9%), proteinuria (0%), and microscopic hematuria (1.4%). The ECLD group showed a lower posttransplantation 1-year eGFR than that of the standard criteria living donor (SCLD) group (66.9 ± 16.0 vs 58.3 ± 11.2; P < .001). Graft survival was not different among the donor types (P = .518).


CONCLUSIONS
eCDs were 27.3% of the total kidney donors. Posttransplantation 1-year eGFR was lower in the ECD group. However, there was no difference in the graft survival among the different donor types.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
J C
JC
Jeong
M-G
MG
Kim
H
H
Ro
Y J
YJ
Kim
H C
HC
Park
H Y
HY
Kwon
H J
HJ
Jeon
J
J
Ha
C
C
Ahn
J
J
Yang
D000293:Adolescent; D000328:Adult; D000368:Aged; D046148:Donor Selection; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens