THE KIDNEYS THAT NOBODY WANTED - SUPPORT FOR THE UTILIZATION OF EXPANDED CRITERIA DONORS

The continuing shortage of cadaveric donors necessitates constant reap praisal of donor refusal criteria. From 1/1/95 to 3/20/96, 180 renal t ransplants were performed at our center. Of these, 26 were kidney/panc reas, 30 pediatric, 37 live donor adult, and 87 adult cadaveric renal transplants (CRT). In the CRT group there were 31 recipients of kidney s that all other local transplant centers declined. We retrospectively compared this group of kidneys that nobody wanted (KNW) to the remain ing 56 CRTs (controls) performed at our center during the same period. Of the 31 recipients of KNW, 18 received kidneys declined for reasons of advanced age, defined as greater than or equal to 60 years (includ ing 8 who also had a history of hypertension, 4 who also had >10% scle rosed glomeruli on biopsy, and 3 also declined based upon donor qualit y because of acute injury), 8 for donor quality alone (e.g., prolonged hypotension), 3 on the basis of biopsy results alone, and 2 for anato mic abnormalities. Twelve recipients of KNW were ''dual transplanted'' with both donor kidneys. Of 27 donor variables compared between the K NW and control groups, only donor age (52+/-17 versus 40+/-17 years, r espectively) and lowest total 4-hr urine output (327+/-208 versus 507/-437 cc, respectively) proved to be significantly different (p less t han or equal to 0.05). Of the 25 recipient variables examined, a signi ficant difference was found only in serum creatinine at one month post transplant (2.6+/-1.8 versus 1.8+/-1.0 mg/dl, respectively), although there was no difference in serum creatinine at three and six months. A ctuarial one year patient (100 vs. 95%) and graft (97 vs. 91%) surviva l, KNW vs. controls respectively, are excellent to date. Further analy ses showed no differences in outcome variables between recipients of K NW versus controls when the donor age was greater than or equal to 60 years. Similar outcome was achieved by transplanting both kidneys from a KNW donor into a single recipient as compared with single-kidney tr ansplantation from control donors. Careful donor-recipient pairing usi ng kidneys from advanced-age donors for smaller, advanced-age recipien ts provided good short-term outcome. In conclusion, there was no signi ficant difference in short-term outcome in recipients of KNW versus co ntrols despite differences in donor age and lowest total 4-hr urine ou tput. We believe that, with careful consideration, existing donor sele ction criteria can be expanded to include certain donors previously co nsidered unusable.