title: Prediction of three-year outcome of renal transplantation from optimal donors versus expanded criteria donors.
abstract: OBJECTIVE
  The shortage in organ supply has required the use of expanded criteria donors (ECD) for kidney transplantation. Current pre-transplant evaluations of ECD organs are based on histological, clinical or mixed criteria. This monocentric study investigates the predictivity of Karpinski's histological score on 3-year graft function in renal transplant. Ex-post classification using Nyberg's score was carried out to assess the reliability of a purely clinical score and its applicability for organ allocation.
  
  
  METHODS
  We evaluated 407 deceased donors (251 optimal and 156 ECD) for renal transplants performed between 2001 and 2006. The differences in creatinine levels and MDRD-GFR at transplant and 1, 2 and 3 years post-transplant between optimal donors and ECD were recorded. Amongst ECD organs, the effect of different Karpinski score classes (0-1, 2, 3, 4, double transplants) on 3-year graft outcomes was analyzed. We then compared renal function over time across the Nyberg grades (A, B, C, and D).
  
  
  RESULTS
  Karpinski scores 0-1 and 2 and double transplants were associated with improved graft function compared to scores 3 and 4. Nyberg's clinical score shows a good fit with medium-term outcome and Karpinski's score, but among the donors with a high Nyberg grade (C and D), it fails to differentiate between allocable or non-allocable organs (due to Karpinski's score ≥7).
  
  
  CONCLUSIONS
  Our data demonstrate a correlation of histological damage at the time of transplant with 3-year graft function, but at present we are unable to provide any supposition on the possible outcome of the discarded kidneys.
authors: Section of Nephrology and Renal Transplant, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy. gaetano.lamanna@unibo.it
authors: Gaetano
authors: G
authors: La Manna
authors: Giorgia
authors: G
authors: Comai
authors: Maria L
authors: ML
authors: Cappuccilli
authors: Giovanni
authors: G
authors: Liviano D'Arcangelo
authors: Benedetta
authors: B
authors: Fabbrizio
authors: Chiara
authors: C
authors: Valentini
authors: Elisa
authors: E
authors: Carretta
authors: Matteo
authors: M
authors: Ravaioli
authors: Maria P
authors: MP
authors: Scolari
authors: Lorenza
authors: L
authors: Ridolfi
authors: Giorgio
authors: G
authors: Feliciangeli
authors: Franco W
authors: FW
authors: Grigioni
authors: Antonio D
authors: AD
authors: Pinna
authors: Sergio
authors: S
authors: Stefoni
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology* / Q000502:physiology*; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D003404:Creatinine