Transplantation of kidneys from expanded criteria donors.

BACKGROUND: The critical shortage of organs for transplantation has resulted in a controversial expansion of the criteria used to define a suitable cadaveric organ donor. The shortage of kidneys has a particularly hard impact on those patients on the waiting list who have uncommon major histocompatibility antigens or who are highly immunized.
METHODS: To determine outcomes between patients receiving grafts from expanded criteria donors (ECDs) and others, a retrospective review of 105 consecutive kidney transplantations performed at a single institution during a 3 1/2 year period was conducted. A total of 44 (41.9%) patients received kidneys from ECDs, 45 (42.9%) from conventional cadaveric donors, and 16 (15.2%) from live donors. All patients were treated by the same physicians and received either triple or quadruple sequential immunosuppressive therapy. In general, high risk recipients did not receive kidneys from ECDs.
RESULTS: Actuarial graft survival, incidence of delayed function, length of stay, and hospital charges were not significantly different between the ECD and conventional cadaveric donor groups of recipients. A higher incidence of urinary complications occurred in the ECD group (p=0.03). This incidence was noted primarily in the recipients of kidneys from donors 5 years of age or younger. However, no allografts were lost as a result of urinary complications. ECD kidneys that were imported from outside the local catchment area accounted for approximately 25% of all cadaveric transplantations performed.
CONCLUSIONS: With appropriate selection of organs from ECDs, acceptable results can be obtained. ECD organs can serve to partially alleviate the extreme organ shortage. These organs should be procured and made available to those centers willing to use them.