title: Identification of expanded-criteria donor kidney grafts at lower risk of delayed graft function.
abstract: BACKGROUND
  Organ shortage leads to the increased use of expanded-criteria donor (ECD) kidneys, which contribute to a higher risk of delayed graft function (DGF) after transplantation. The aim of this study was to determine factors that may better predict the risk of DGF.
  
  
  METHODS
  Histologic assessments of donor renal biopsy were used with other clinical variables to predict the risk of DGF after kidney transplantation. The total Banff score equaled the sum of interstitial fibrosis (CI), tubular atrophy, arteriolar hyaline thickening, fibrous intimal thickening (CV), and fraction of sclerotized glomeruli.
  
  
  RESULTS
  In total, 126 of 344 patients developed DGF after kidney transplantation. The histologic score for CI, tubular atrophy, and CV and the total Banff score were increased in patients with DGF. Only CI and CV were independent predictors of DGF (P<0.01). A CIV score (CI+CV; odds ratio, 2.68; 95% confidence interval, 1.55-4.66; P<0.001) was superior to the combination of the total Banff score (odds ratio, 1.48; 95% confidence interval, 0.85-2.55; P=NS). A CIV score≥1, donor age more than 51 years, and anoxia donor brain injury were associated with the highest risk of DGF. A CIV<1 identified a subgroup of ECDs at a lower risk of DGF comparable with standard-criteria donors (29.3% vs. 28.4%).
  
  
  CONCLUSIONS
  Composite CIV score better identifies ECD kidneys with a lower risk of developing DGF. Morphologic evaluation of ECD kidneys and donor characteristics may improve kidney allocation.
authors.affiliation: 1 Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 2 Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 3 Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 4 Center for Cardiovascular Prevention of the First Faculty of Medicine Charles University and Thomayer Hospital, Prague, Czech Republic. 5 International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic. 6 Clinical and Transplant Pathology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 7 Transplantcenter, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 8 Address correspondence to: Peter Balaz, M.D., Ph.D., Department of Transplant Surgery, Transplantcenter, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 14821 Prague, Czech Republic.
authors.forename: Peter
authors.initials: P
authors.lastname: Balaz
authors.forename: Slavomir
authors.initials: S
authors.lastname: Rokosny
authors.forename: Mariana
authors.initials: M
authors.lastname: Wohlfahrtova
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlfahrt
authors.forename: Anastazie
authors.initials: A
authors.lastname: Bartonova
authors.forename: Eva
authors.initials: E
authors.lastname: Pokorna
authors.forename: Eva
authors.initials: E
authors.lastname: Honsova
authors.forename: Ondrej
authors.initials: O
authors.lastname: Viklicky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D051799:Delayed Graft Function / Q000209:etiology / Q000517:prevention & control*; D046148:Donor Selection / Q000379:methods*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D055815:Young Adult