A REVIEW OF THE KIDNEYS THAT NOBODY WANTED

Background. We previously reported excellent outcome at 6 months after transplantation in recipients of expanded criteria donor kidneys that other local centers had declined, kidneys that nobody wanted (KNW), v ersus controls. We now report follow-up after 23 months, Methods, We r etrospectively reviewed 27 donor and 24 recipient characteristics in 1 26 adult recipients of transplants from January 1, 1995, to November 2 5, 1996, Results, Donors of control kidneys versus KNW were younger an d had significantly higher minimum 4-hr urine output, Recipients of co ntrol kidneys versus KNW had significantly more HLA matches and lower 3-month posttransplant serum creatinine levels, Patient and graft surv ival rates were similar between the control kidneys versus the KNW, We also compared the control kidneys and KNW with regard to prompt funct ion or delayed graft function and satisfactory versus unsatisfactory f unction (unsatisfactory: serum creatinine greater than or equal to 2.5 ml/dl or graft loss at 6 months) to identify donor and recipient char acteristics associated with delayed graft function and unsatisfactory outcome. The incidence of rejection was significantly lower in control kidneys and KNW with satisfactory function versus control kidneys and KNW with unsatisfactory function. Conclusions, These data demonstrate : (1) similar graft survival at 12 months, (2) lower donor age, (3) hi gher minimum 4-hr urine output, and (4) more HLA matches in recipients of control kidneys versus KNW, Optimal outcome was achieved in recipi ents of control kidneys and KNW with prompt function and satisfactory function based upon serum creatinine in the first 6 months and in reci pients with lower rates of rejection, Although outcome is dependent up on many donor and recipient variables, we believe that with careful do nor and recipient selection, excellent outcome can be achieved using e xpanded criteria donor kidneys.