title: Safety and Effectiveness of Marginal Donor in Living Kidney Transplantation.
abstract: BACKGROUND
  We evaluated the safety and feasibility of living kidney transplantation from marginal donors.
  
  
  METHODS
  Between June 2006 and March 2015, we performed 61 living related renal transplantations at two renal transplantation centers. Marginal donors were defined as those who were older than 70 years or who had hypertension, reduced renal function, body mass index greater than 30 kg/m(2), or mildly impaired glucose tolerance. We retrospectively compared renal function and graft survival between marginal and standard living donor kidney transplantations. To evaluate renal function, creatinine clearance (CCr) was preoperatively used for donors, and estimated glomerular filtration rate (eGFR) was postoperatively used for donors and recipients.
  
  
  RESULTS
  Among 61 donors, 14 (23%) met the marginal criteria, the major reason being hypertension (91%). The mean age tended to be higher in the marginal group. Preoperative eGFR was significantly lower in the marginal group, whereas postoperative renal function decline ratio at two years was not significantly different between the groups (67% vs 67%, P = .960). Five-year graft survival rates were not significantly different between the two groups. However, recipient eGFR 1 year after kidney transplantation was lower in the marginal group than in the standard group (44 ± 8 vs 55 ± 9 in eGFR, P = .003).
  
  
  CONCLUSIONS
  No significant differences were observed between the groups regarding donor renal function. Careful marginal donor selection can be safe and feasible for donors and recipients of living kidney transplantation; however, it may have a negative impact on recipient renal function.
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Oikawa
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. Electronic address: shingorilla2@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Hatakeyama
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Narita
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hosogoe
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Imai
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yoneyama
authors.affiliation: Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Koie
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Murakami
authors.affiliation: Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Saitoh
authors.affiliation: Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Funyu
authors.affiliation: Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Narumi
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Ohyama
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000097:blood; D007668:Kidney / Q000378:metabolism; D016030:Kidney Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors / Q000145:classification*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D013997:Time Factors; D019737:Transplants / Q000378:metabolism; D016896:Treatment Outcome