title: Increased risk of graft failure and mortality in Dutch recipients receiving an expanded criteria donor kidney transplant.
abstract: Survival of expanded criteria donor (ECD) kidneys and their recipients has not been thoroughly evaluated in Europe. Therefore, we compared the outcome of ECD and non-ECD kidney transplantations in a Dutch cohort, stratifying by age and diabetes. In all first Dutch kidney transplants in recipients ≥18 years between 1995 and 2005, both relative risks (hazard ratios, HR) and adjusted absolute risk differences (RD) for ECD kidney transplantation were analysed. In 3062 transplantations [recipient age 49.0 (12.8) years; 20% ECD], ECD kidney transplantation was associated with graft failure including death [HR 1.62 (1.44-1.82)]. The adjusted HR was lower in recipients ≥60 years of age [1.32 (1.07-1.63)] than in recipients 40-59 years [1.71 (1.44-2.02) P = 0.12 for comparison with ≥60 years] and recipients 18-39 years [1.92 (1.42-2.62) P = 0.03 for comparison with ≥60 years]. RDs showed a similar pattern. In diabetics, the risks for graft failure and death were higher than in the nondiabetics. ECD kidney grafts have a poorer prognosis than non-ECD grafts, especially in younger recipients (<60 years), and diabetic recipients. Further studies and ethical discussions should reveal whether ECD kidneys should preferentially be allocated to specific subgroups, such as elderly and nondiabetic individuals.
authors.affiliation: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Frans J
authors.initials: FJ
authors.lastname: van Ittersum
authors.affiliation: Nefrovisie Foundation, Utrecht, The Netherlands.
authors.forename: Aline C
authors.initials: AC
authors.lastname: Hemke
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Luuk B
authors.initials: LB
authors.lastname: Hilbrands
authors.affiliation: Department of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Maarten H L
authors.initials: MH
authors.lastname: Christiaans
authors.affiliation: Department of Nephrology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Joke I
authors.initials: JI
authors.lastname: Roodnat
authors.affiliation: Nefrovisie Foundation, Utrecht, The Netherlands.
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Hoitsma
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Merel
authors.initials: M
authors.lastname: van Diepen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; 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 / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012306:Risk; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
keywords: donation after brain death; donation after cardiac death; expanded criteria donor; graft survival; kidney transplantation; patient survival