title: Long-Term Outcomes in Kidney Transplantation From Expanded-Criteria Donors After Circulatory Death.
abstract: The number of recipients waiting for a transplant is increasing. In Japan, there is more frequent use of organs from expanded-criteria donors (ECDs) after circulatory death. We retrospectively analyzed long-term outcomes of kidney transplantation (KT) from expanded-criteria donation after circulatory death (DCD). From 1995 to 2013, 97 cases of KT from DCD donors were performed in our department. Death-censored graft survival rates of ECD kidneys (n = 50) versus standard-criteria deceased-donor (SCD) kidneys (n = 47) for 1, 5, and 10 years after transplantation were 84.0% vs 97.9%, 74.8% vs 95.6%, and 70.2% vs 81.8%, respectively. No significant difference was found between the 2 groups (P = .102). Kidneys from donors with a history of hypertension (HTN) and cerebrovascular events (CVE) and contribution from older donors had significantly lower 10-year graft survival rates (P values of .010, .036, and .050, respectively). Cox proportional hazard regression analyses showed donor age to be significantly associated with long-term graft survival independently from other factors. These results suggest that ECD kidneys remain an acceptable alternative to dialysis under certain conditions. Increased donor age was a significant risk factor determining long-term graft function. Moreover, comorbidities of HTN and CVE could become significant risk factors, especially in older donors.
authors.affiliation: Department of Surgery III, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: tomita@surgery.wisc.edu.
authors.forename: Y
authors.initials: Y
authors.lastname: Tomita
authors.affiliation: Department of Transplant Surgery, Atami Hospital, International University of Health and Welfare, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tojimbara
authors.affiliation: Department of Surgery III, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Iwadoh
authors.affiliation: Department of Surgery III, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Nakajima
authors.affiliation: Department of Surgery III, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fuchinoue
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006323:Heart Arrest; D006801:Humans; D007564:Japan; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D019737:Transplants / Q000503:physiopathology*; D016896:Treatment Outcome