Is it safe to use a kidney from an expanded criteria donor?

The use of expanded criteria donor (ECD) kidneys has been encouraged to enlarge the donor pools due to the shortage of donors. However, a major concern with ECD kidneys is poor long-term graft survival. The objective of this study was to determine whether ECD kidneys had a negative impact on graft survival.

We analyzed all deceased donor renal transplantations at our center from September 1995 to December 2009.

ECD donors show characteristics, such as comparatively older age, a history of hypertension and diabetes, the use of norepinephrine, high serum creatinine levels and deceased donor scores, and decreased albumin levels and estimated glomerular filtration rates. However, the occurrence of delayed graft function and primary nonfunction among ECD grafts was comparable to those of standard criteria donor (SCD) grafts. Graft survival was not significantly different between the two groups. Only serum creatinine levels at 3, 6, and 9 months after transplantation were lower in the ECD than the SCD group. Multivariate analysis identified longer hospital stay after transplantation, delayed graft function, and acute rejection episodes as independent predictors of poor graft survival.

Graft survival of ECD kidney was comparable to that of SCD kidneys. We observed that donor factors prior to procurement were not risk factors for graft failure.