Impact of expanded criteria donors on outcomes of recipients after kidney transplantation.

BACKGROUND: Age and comorbidities of brain-dead donors have increased throughout the last decade. The use of expanded criteria donors (ECD) has become a common clinical practice. The objective of the present study was to compare outcomes of patients who underwent kidney transplantation from ECD versus standard criteria donors (SCD). METHODS: We studied 1375 adult recipients of kidney transplantations from 792 deceased donors in six Quebec centers between 2003 and 2009. Patient and graft survivals were analyzed using uni- and multivariate methods in regard to the effects of donor and recipient characteristics. ECD were defined per United Network for Organ Sharing: criteria age >60 years of age or age 50 to 59 years with two of three associated risk factors-history of cerebrovascular accident, hypertension, or elevated serum creatinine Mean follow-up was 3.5 ± 2 years. RESULTS: Among the 792 donors, 510 SCD (64%) and 282 ECD (36%) were used for 1375 kidney transplant recipients. ECD had no effect on patient (P = .47) or graft (P = .28) survival. Cox proportional hazards regression analysis showed female donors (relative risk [RR] 1.75, P = .008), recipient age (RR 1.07, P = .0001), and waiting time be for transplantation (RR 1.000, P = .0001) to be associated with a greater risk of death after transplantation. Donor (RR 1.018, P = .0099) and recipient (RR 1.013, P = .0387) age and recipient waiting time for transplantation (RR 1.000, P = .0048) were also associated with a greater risk of graft loss. CONCLUSION: The use of SCD or ECD had no impact on patient or graft survival after kidney transplantation. Donor and recipient ages as well as waiting time for transplantation were related to graft loss. Waiting time remains a significant factor affecting outcomes; efforts should aim to decrease this period.

Impact of expanded-criteria donors on patient survival after heart, lung, liver and combined organ transplantation.

BACKGROUND: The age and comorbidities of brain-dead donors have increased throughout the past decade. The use of expanded-criteria donors (ECDs) has become a common clinical practice. The objective of the present study was to compare outcomes of patients who underwent heart, lung, liver, and combined organ transplantations from expanded- versus standard-criteria donors (SCDs). METHODS: We studied 867 adult patients who received deceased-donor organs in 6 Québec centers from 2003 to 2009. Patient survival was analyzed with the use of univariate methods with respect to the effect of donor and recipient characteristics. ECDs were defined according to United Network for Organ Sharing criteria: age >60 years (or 50-59 years with 2 associated risk factors), and history of cerebrovascular accident, hypertension, or elevated serum creatinine. RESULTS: Among the 664 donors, 438 were SCDs (66%) and 226 ECDs (34%). Two-year recipient survival averaged 78 ± 2% versus 77 ± 3% in SCD and ECD groups, respectively, following liver; 78 ± 3% versus 74 ± 10% after lung 87 ± 3% versus 72 ± 12% following heart, and 75 ± 9% and 67 ± 19% after combined organ transplantation (P > .05 for all organs). CONCLUSION: The current definition of SCD and ECD had no effect on patient survival after lung or liver transplantation. There was a trend toward decreased patient survival among heart and combined organ transplant recipients of ECDs. Specific donor critieria should be defined to quantify donor risk factors for each extrarenal organ.