Kidney transplantation from deceased donors with elevated serum creatinine.
BACKGROUND
Elevated donor serum creatinine has been associated with inferior graft survival in kidney transplantation (KT). The aim of this study was to evaluate the impact of elevated donor serum creatinine on short and long-term outcomes and to determine possible ways to optimize the use of these organs.


METHODS
All kidney transplants from 01-2000 to 12-2012 with donor creatinine ≥ 2 mg/dl were considered. Risk factors for delayed graft function (DGF) were explored with uni- and multivariate regression analyses. Donor and recipient data were analyzed with uni- and multivariate cox proportional hazard analyses. Graft and patient survival were calculated using the Kaplan-Meier method.


RESULTS
Seventy-eight patients were considered. Median recipient age and waiting time on dialysis were 53 years and 5.1 years, respectively. After a median follow-up of 6.2 years, 63 patients are alive. 1, 3, and 5-year graft and patient survival rates were 92, 89, and 89 % and 96, 93, and 89 %, respectively. Serum creatinine level at procurement and recipient's dialysis time prior to KT were predictors of DGF in multivariate analysis (p = 0.0164 and p = 0.0101, respectively). Charlson comorbidity score retained statistical significance by multivariate regression analysis for graft survival (p = 0.0321). Recipient age (p = 0.0035) was predictive of patient survival by multivariate analysis.


CONCLUSIONS
Satisfactory long-term kidney transplant outcomes in the setting of elevated donor serum creatinine ≥2 mg/dl can be achieved when donor creatinine is <3.5 mg/dl, and the recipient has low comorbidities, is under 56 years of age, and remains in dialysis prior to KT for <6.8 years.
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
Anja
A
Gallinat
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
Sabine
S
Leerhoff
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
Andreas
A
Paul
Department of Surgery, North Shore University Hospital, Manhasset, NY, USA.
Ernesto P
EP
Molmenti
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
Maren
M
Schulze
Department of Nephrology, University Hospital Essen, Essen, Germany.
Oliver
O
Witzke
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany. georgios.sotiropoulos@uni-due.de.
Georgios C
GC
Sotiropoulos
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D003404:Creatinine / Q000097:blood*; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D003404:Creatinine
Acute kidney injury; Delayed graft function; Expanded criteria donor; Kidney allocation; Kidney transplantation; Marginal donor