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Abstract
Background:
This study was conducted in order to evaluate the propriety of expanded donor criteria in Korea and to identify the preoperative factors influencing allograft survival and function.
Methods:
We studied 404 patients who received deceased renal transplants from five transplantation centers of 2, 3 territory from 2000 to 2010. Differences in 1-year graft function, delayed graft function (DGF) rate, and graft survival rate between the standard criteria donor (SCD) and expanded criteria donor (ECD) were compared retrospectively. The preoperative factors influencing graft function and graft survival were analysed.
Results:
SCD showed significantly better 1-year graft function than ECD (P=0.011). No differences in 1-year acute rejection rate were observed between SCD (13.2%) and ECD (16.9%) (P=0.449). Significantly higher DGF rate was observed for ECD (25.4%) than for SCD (14.1%) (P=0.022). Graft type had no significant influence on 5-year graft survival (SCD 94.5% vs. ECD 93.7%) (P=0.835). Advanced donor age (P=0.001), donor hypertension history (P=0.047), high serum creatinine (P=0.002), and cerebral infarction as cause of death (P=0.004) had a negative influence on 1-year allograft function. Significantly low graft survival was observed for advanced donor age (P=0.002).
Conclusions:
Graft function, DGF rates of ECD were poorer than those of SCD. Graft survival rate of ECD was comparable to that of SCD kidney. Korean Network for Organ Sharing expanded criteria may underestimate the organ quality of deceased kidney and modification may be needed in order to expand the potential donor pool through nationwide study.
REFERENCES
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Fig. 1.
Renal allograft survival rate according to donor criteria: standard criteria donor (SCD) versus expanded criteria donor (ECD).
Fig. 3.
Total of 71 patients were assorted as expanded criteria donor (ECD) by Korean Network for Organ Sharing (KONOS) criteria and only 27 patients (38.0%) of them were expanded donor by United Network for Organ Sharing (UNOS) criteria. Abbreviation: SCD, standard criteria donor.
Fig. 4.
Kidney grade determined by Nyberg donor score in 71 patients of Korean Network for Organ Sharing expanded criteria donor.
Table 1.
Comparison of recipient and donor characteristics
Table 2.
Causes which assorted deceased donor as expanded criteria donor
| Variable | ECD (n=71) |
|---|---|
| Nonheart beating donor | 3 (4.2) |
| Hypotensive attack a | 17 (23.9) |
| Age ≥60 years | 16 (22.5) |
| sCr ≥3.0 mg/dL or CrCl ≤60 mL/min | 24 (33.8) |
| Proteinuria (≥++) ≥2 times | 8 (11.3) |
| Proteinuria (≥++) ≥2 times+sCr ≥3.0 mg/dL | 2 (2.8) |
| Age ≥60 years+sCr ≥3.0 mg/dL | 1 (1.4) |
Table 3.
Comparison of clinical results in terms of estimated glomerular filtration rate, acute resection episode, and delayed graft function between standard criteria donor and expanded criteria donor
Table 4.
Donor variables associated with recipient estimated glomerular filtration rate at 1 year
Table 5.
Multivariate regression models for risk factors of 1-year estimated glomerular filtration rate after deceased donor kidney transplantation
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