Introduction:
In cadaveric renal transplants, the use of Expanded Criteria Donors (ECD) has been steadily increasing worldwide to address the growing shortage of donor organs. While outcomes from ECD transplants are generally inferior compared to those from Standard Criteria Donors (SCD), a thorough evaluation of donor characteristics based on predefined criteria can help better identify high-risk patients and more accurately predict their long-term outcomes. With this aim, we assessed the overall incidence of graft dysfunction, all-cause mortality, and graft survival in our deceased donor renal transplant recipients at 1 year period. Further we compared the overall outcomes between the extended criteria donor (ECD) and the standard criteria donor kidneys (SCD).
Methods:
We performed a retrospective analysis of 155 kidney transplants at our center between 2018 and August 2023. We analyzed donor characteristics and patient outcomes, including graft dysfunction, patient survival, mortality, incidence of rejection, and infections over a one-year follow-up period. Recipients were categorized into four groups based on donor age: ECD60 (n=23), ECD50-59 (n=17), SCD50-59 (n=20), and SCD<50 (n=95). The criteria for extended criteria donor (ECD) kidneys followed the 2002 UNOS guidelines, which consider factors such as donor age, history of hypertension, creatinine levels, and cause of death. All ECD kidneys underwent pre-transplant biopsy, and only those with a MAPI score of less than 7 were accepted for transplantation. The outcomes of the recipients were analyzed over one-year period
Results:
Among the ECD60 group, the 1-year all-cause mortality was 26% (6/23), higher than any other group, with two cases of graft loss due to acute rejection. In contrast, the SCD<50 group exhibited a significantly lower mortality rate of 3% (3/95), primarily as a result of infections, 5% graft loss (5/95) secondary to rejection. In the age-matched comparison between the ECD50-59 (n=17) and SCD50-59(n=20) groups, the incidence of delayed graft function (DGF) was higher in the ECD50-59 group (41% vs. 15%, p < 0.001.). Despite this, there was no statistically significant difference in 1-year mortality between the two groups (17% vs. 10%, p=0.44), with patient survival at one year being 82% in the ECD50-59 group and 90% in the SCD50-59 group.
Conclusions:
Our findings suggest that while transplants using ECD kidneys, particularly from older donors, are associated with higher rates of mortality and graft loss compared to SCD kidneys. In age matched group comparison, the incidence of delayed graft function was significantly higher in the ECD50-59 group compared to the SCD50-59 group. However, this did not translate into a statistically significant difference in 1-year mortality or patient survival rates between the two groups. These findings suggest that while ECD kidneys, particularly from donors aged 50-59, may carry a risk of early graft complications, this does not necessarily impact short-term survival outcomes, emphasizing the potential viability of ECD kidneys in appropriate clinical contexts.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.