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21 May 2009

Assessment of kidneys procured from expanded criteria donors before transplantation

P Domagała, A Kwiatkowski, A Perkowska-Ptasińska, M Wszoła, K Ostrowski, A Chmura

Ann Transplant 2009; 14(1): 54-54 :: ID: 880397

Abstract

Background: Using expanded criteria donor's (ECD) organs is one of the strategies for making more transplants available. In order to reduce the number of post-transplant complications there is a need to create a comprehensive system of kidney evaluation prior to transplantation, especially for kidneys harvested from expanded donors. Aim: The aim of this study was to assess which factors are most suitable for kidney evaluation before transplantation.
Material/Methods: One hundred and seventy two patients received cadaveric renal transplants between January 1[sup]st[/sup], 2006 and August 31[sup]st[/sup], 2008. Data on donors, recipients and preservation was collected. Patient's and graft survival as well as immediate, delayed and slow graft function were analysed. Kidney recipient's function was assessed by serum creatinine concentration and creatinine clearance at seven days, 1, 3, 6, 12 and 24 months post transplantation. The follow-up was completed on November 30th, 2008.
Results: Average 1-year graft's survival was 86.9% for the whole group and mean creatinine concentration was 1.58 mg/dl. One case of primary nonfunction was observed (0.6%). More than 25% of transplanted kidneys were harvested from ECD. A lower graft survival at six months after transplantation was observed in the group of organs harvested from ECD, those with histological lesions (HL) and those in which the flow in the fourth hour of machine perfusion was lower than 0.4ml/g (table). By using logistic regression model, chronic histological changes were proven to have influence on kidney's survival at six months post transplantation. Additionally, ECD kidney recipients were more likely to have a creatinine concentration higher than 2mg/dl at six months post transplantation.
Conclusions: Pre-transplant evaluation of expanded criteria donor's kidney
should include three variables: donor parameters, histological findings and
machine perfusion parameters.

Keywords: Kidney Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358