title: Decision Making by Young Transplant Surgeons Regarding Expanded-Criteria Donors With Acute Kidney Injury or Allocation Failure.
abstract: BACKGROUND
  The utilization of expanded-criteria donors (ECDs) has increased to overcome donor shortages. Unfortunately, the discard rate has also increased, especially in ECDs with acute kidney injury (AKI). We evaluated the outcomes of kidney transplantation in ECDs and standard-criteria donors (SCDs) with and without AKI.
  
  
  METHODS
  We reviewed the medical records of patients who underwent kidney transplantation. We used the AKI definition published by the Kidney Disease: Improving Global Outcomes group and reviewed the demographic characteristics of donors and recipients. We analyzed transplantation outcomes.
  
  
  RESULTS
  Twenty-seven patients underwent kidney transplantation from ECDs with AKI (n = 6) or without AKI (n = 5) and SCDs with AKI (n = 6) or without AKI (n = 10). Initial creatinine and estimated glomerular filtration rate (eGFR) were not significantly different between the groups. The incidence of delayed graft function was highest in ECDs with AKI (n = 3; 36.4%), but this was not a significantly difference. There was no difference in the last creatinine and eGFR in ECDs with AKI (1.32 mg/dL, 58.7 mL/min/1.73 m(2)), ECDs without AKI (1.67 mg/dL, 44.2 mL/min/1.73 m(2)), SCDs with AKI (0.94 mg/dL, 81.5 mL/min/1.73 m(2)) and SCDs without AKI (0.97 mg/dL, 81.8 mL/min/1.73 m(2)).
  
  
  CONCLUSIONS
  As the donor pool is extended to ECDs, young transplant surgeons may increasingly face decisions regarding ECDs with AKI or allocation failure. There is no consensus regarding discard criteria. However, if the donor showed initially normal creatinine levels or if dual-kidney transplantation can be performed, young transplant surgeons should not hesitate to use ECDs with AKI or allocation failure.
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: D
authors.initials: D
authors.lastname: Jung
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea. Electronic address: drgs01@yonsei.ac.kr.
authors.forename: S H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Pathology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: M
authors.initials: M
authors.lastname: Eom
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: J W
authors.initials: JW
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: B G
authors.initials: BG
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: S O
authors.initials: SO
authors.lastname: Choi
mesh_terms: D058186:Acute Kidney Injury / Q000601:surgery*; D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods*; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000378:metabolism; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D066231:Surgeons / Q000523:psychology; D019737:Transplants / Q000145:classification* / Q000378:metabolism
chemical_list: D003404:Creatinine