title: Satisfactory outcomes with usage of extended criteria donor (ECD) kidneys in re-transplant recipients.
abstract: BACKGROUND
  The use of extended criteria donor (ECD) kidneys have increased substantially and the benefit recognized in certain populations. Our institution has maintained a policy of aggressively utilizing ECD kidneys, even among those who have failed a previous transplant. Previous reports on the benefit of ECD in re-transplants have shown equivocal outcomes. We sought to determine if our experience would support or refute this finding.
  
  
  METHODS
  This is a retrospective study of 19 ECD re-transplants between 2002 and 2010. We compared 1 and 3 year outcomes with 95 patients with standard criteria donor (SCD) re-transplant and 169 patients with first time transplant using ECD kidneys. Outcomes and demographics were evaluated including delayed graft function (DGF), HTN, DM, cold ischemia time (CIT), BMI, donor age and prior allograft nephrectomies using a Cox Proportional Hazard model. We compared patient and graft survival using the log rank test.
  
  
  RESULTS
  Patient survival were similar among the first time ECD and ECD re-transplant groups at 1 year (p=0.9547) and at 3 years (p=0.8287). Graft survival was also similar between first time ECD and ECD re-transplant groups at 1 year (p=0.4781) and at 3 years (p=0.8519). As expected, SCD re-transplant had better outcomes than the other groups.
  
  
  CONCLUSIONS
  1 and 3 years graft and patient survival among first time ECD transplants and ECD re-transplants are similar. As the list of patients on dialysis is ever growing, it may be prudent to aggressively explore the utility of using ECD kidneys in re-transplant patients.
authors.affiliation: Albert Einstein Healthcare Network, Philadelphia, PA, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ortiz
authors.forename: Afshin
authors.initials: A
authors.lastname: Parsikia
authors.forename: Po Nan
authors.initials: PN
authors.lastname: Chang
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Jamil
authors.forename: Stalin
authors.initials: S
authors.lastname: Campos
authors.forename: Kamran
authors.initials: K
authors.lastname: Khanmoradi
authors.forename: Radi
authors.initials: R
authors.lastname: Zaki
authors.forename: Janani
authors.initials: J
authors.lastname: Rangaswami
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome