title: Combined predictive value of the expanded donor criteria for long-term graft survival of kidneys from donors after cardiac death: A single-center experience over three decades.
abstract: OBJECTIVE
  Kidneys procured from the deceased hold great potential for expanding the donor pool. The aims of the present study were to investigate the post-transplant outcomes of renal allografts recovered from donors after cardiac death, to identify risk factors affecting the renal prognosis and to compare the long-term survival from donors after cardiac death according to the number of risk factors shown by expanded criteria donors.
  
  
  METHODS
  A total of 443 grafts recovered using an in situ regional cooling technique from 1983 to 2011 were assessed. To assess the combined predictive value of the significant expanded criteria donor risk criteria, the patients were divided into three groups: those with no expanded criteria donor risk factors (no risk), one expanded criteria donor risk factor (single-risk) and two or more expanded criteria donor risk factors (multiple-risk).
  
  
  RESULTS
  Among the donor factors, age ≥50 years, hypertension, maximum serum creatinine level ≥1.5 mg/dL and a warm ischemia time ≥30 min were identified as independent predictors of long-term graft failure on multivariate analysis. Regarding the expanded criteria donors criteria for marginal donors, cerebrovascular disease, hypertension and maximum serum creatinine level ≥1.5 mg/dL were identified as significant predictors on univariate analysis. The single- and multiple-risk groups showed 2.01- and 2.40-fold higher risks of graft loss, respectively.
  
  
  CONCLUSIONS
  Renal grafts recovered from donors after cardiac death donors have a good renal function with an excellent long-term graft survival. However, an increased number of expanded criteria donors risk factors increase the risk of graft loss.
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kusaka
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Fukami
authors.affiliation: Department of Urology, Nagoya Memorial Hospital, Nagoya, Aichi, Japan.
authors.forename: Tamio
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirose
authors.affiliation: Division of Medical Statistics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Organ Transplant Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kenmochi
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Shiroki
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Hoshinaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D016757:Death, Sudden, Cardiac; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000503:physiopathology; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D007223:Infant; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: delayed graft function; donation after cardiac death; expanded criteria donor; ischemia/reperfusion injury; kidney transplantation