Expanded criteria donor kidneys for retransplantation United Network for Organ Sharing update: proceed with caution

This study analyzed outcomes of retransplantation from expanded criteria donors (ECD) over the last two decades to determine the benefits and risks of using ECD kidneys for retransplantation. Data from the United Network for Organ Sharing database were collected and analyzed. Graft survival, death-censored graft survival, and patient survival for retransplantation with ECD kidneys (re-ECD) were reported and compared with primary transplantation with ECD kidneys (prim-ECD) and retransplantation with standard criteria donor kidneys (re-SCD). Re-ECD kidneys had higher risk of graft failure compared with prim-ECD (hazard ratio [HR] = 1.19) and to re-SCD (HR = 1.76). Patient survival was better in re-ECD compared with prim-ECD (HR = 0.89) but was worse than re-SCD (HR = 1.82). After censoring the patients who died with a functioning graft, re-ECD had a higher mortality risk compared with prim-ECD (HR = 1.45) and re-SCD (HR = 1.79). Transplantation improves quality of life and reduces healthcare costs, and due to the risk associated with resumption of hemodialysis and the longer waiting list times for SCD kidneys, there is a benefit to accepting ECD kidneys for select patients requiring retransplantation. Although this benefit exists for select patients, retransplantation with ECD kidneys should be undertaken with trepidation, and appropriate informed consent should be obtained.