TRANSPLANTATION OF KIDNEYS FROM EXPANDED CRITERIA DONORS

Background, The critical shortage of organs for transplantation has re sulted in a controversial expansion of the criteria used to define a s uitable cadaveric organ donor The shortage of kidneys has a particular ly hard impact on those patients on the waiting list who have uncommon major histocompatibility antigens or who are highly immunized, Method s. To determine outcomes between patients receiving grafts from expand ed criteria donors (ECDs) and others, a retrospective review of 105 co nsecutive kidney transplantations performed at a single institution du ring 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 do nors, and 16 (15.2%) from live donors. All patients were treated by th e same physicians and received either triple or quadruple sequential i mmunosuppressive therapy. In general, high risk recipients did not rec eive kidneys from ECDs. Results. Actuarial graft survival, incidence o f delayed function, length of stay, and hospital charges were not sign ificantly different between the ECD and conventional cadaveric donor g roups of recipients. A higher incidence of urinary complications occur red in the ECD group (p = 0.03). This incidence was noted primarily in the recipients of kidneys from donors 5 years of age ol younger. Howe ver, no allografts were last as a result of urinary complications. ECD kidneys that were imported from outside the local catchment area acco unted for approximately 25% of all cadaveric transplantations performe d. Conclusions. With the appropriate selection of organs from ECDs, ac ceptable results can be obtained. ECD organs can serve to partially al leviate the extreme organ shortage. These organs should be procured an d made available to those centers willing to use them.