Kidney transplantation outcomes from expanded criteria donors, standard criteria donors or living donors older than 60 years

Abstract

Objectives: To evaluate outcomes in kidney allograft recipients from donors with expanded criteria (ECD) versus standard criteria (SCD) or living donors (LD)460 years. Methods: We studied all patients who received a kidney between 2005 and 2011, focusing in recipients of kidneys from deceased ECD, SCD and LD 460 years. ECD was any deceased donor 460 years or 450 years with two of the following: hypertension (HTN), stroke as the cause of death, or serum creatinine 41.5 mg/dL. We recorded characteristics of the transplant procedure, patient, graft survival and renal function 1 year after transplantation and at the end of follow-up. Results: Sixhundred and five patients were transplanted between 2005 and 2011 in our department. There were 142 (25.1%) transplantations from ECD, 192 (33.98%) from SCD and 96 (16.99%) from LDs older than 60 years. In a mean follow-up time of 36.4 months, graft survival rates were similar for all groups. Calculated GFR was found statistically different between the ECD and SCD groups, but still satisfactory at first year, and at end of follow-up time. Comparison of the patients, who received transplants from ECD, even older than 70 years, and those from LD 460 years revealed equivalent renal function in short and long term. Conclusions: Utilization of marginal kidneys effectively doubled our deceased transplant volume in the period 2005-2011. Patients' and graft survival were shown similar at the end of follow-up for all groups. Renal outcomes were shown equivalent between the ECD and LD 460 years groups, and although significantly lower between the ECD and the SCD group, were still very satisfactory.

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“…4 In the same frame, it was shown that recipients receiving allografts from extended criteria donors pose a higher risk of SII compared with recipients of standard criteria allografts, 8 despite the satisfactory allograft survival rates compared with living donor and standard criteria allografts. 31 We confirmed this finding despite the OR being only marginally above 1 (1.28).…”

Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study

“…Notably, in a metaanalysis of six clinical trials comparing belatacept with either CsA or tacrolimus, belatacept was associated with significantly greater eGFR at 12, 24 and 36 mo after transplant (32). This result is important from a clinical perspective because recipients of ECD kidneys tend to have statistically significantly lower GFR values than those who receive standard criteria donor kidneys (33)(34)(35)(36). A non-nephrotoxic immunosuppressive regimen may help to maintain ECD renal function, delaying the time that recipients of such kidneys progress to chronic kidney disease, must return to maintenance dialysis and/ or undergo retransplantation.…”

Lower rate of delayed graft function is observed when epidural analgesia for living donor nephrectomy is administered.

“…Living kidney transplantation showed superior results compared to deceased donor kidney transplantation in terms of graft survival, accessibility, waiting time and cost containment for public health services [1][2][3]. For patients undergoing surgical procedures for another one´s benefit, it is important to minimize perioperative risks and inconvenience.…”