Excellent outcome using "impaired" standard criteria donors with elevated serum creatinine

Area of Science:

• Nephrology
• Transplantation Medicine
• Organ Donation

Background:

• The United Network for Organ Sharing (UNOS) promotes using Expanded Criteria Donors (ECD) to increase organ utilization.
• Standard Criteria Donors (SCD) may be under-utilized, with some centers discarding kidneys if serum creatinine (S.Cr) exceeds 2.0 mg/dL at nephrectomy.

Purpose of the Study:

• To evaluate the outcomes of transplanting kidneys from Standard Criteria Donors with elevated serum creatinine (impaired SCD).
• To determine if high serum creatinine alone is a valid reason for discarding deceased donor kidneys.

Main Methods:

• Retrospective review of deceased donor kidney transplants performed between January 1, 2003, and October 1, 2006.
• Analysis of kidneys from impaired SCD (ISCD) with mean S.Cr of 3.2 (range 2.1-4.4), including eight with S.Cr >4.0.
• Evaluation of donor and recipient demographics, HLA matching, post-transplant dialysis needs, length of stay, and graft function.

Main Results:

• Twenty-two impaired SCD kidneys were transplanted, with a mean donor age of 22 years and evidence of rhabdomyolysis.
• Recipient demographics included a mean age of 45 years, 45% African-American, and a mean HLA match of 1.
• All transplanted kidneys demonstrated excellent long-term function, with a mean serum creatinine of 1.7 at one year post-transplant.

Conclusions:

• Elevated serum creatinine in deceased donors should not be the sole criterion for discarding kidneys.
• Transplanting kidneys from impaired SCD can be a viable strategy to increase organ utilization and improve patient outcomes.