To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Expanded Donor Criteria Adversely Affect Kidney Function in Recipients: Presented at ACS URL: http://www.pslgroup.com/dg/22EDE6.htm Doctor's Guide October 15, 2008
By Roberta Friedman, PhD SAN FRANCISCO -- October 15, 2008 -- Kidney transplants using donors with expanded criteria have acceptable results but may be associated with an increase in death rates with functioning grafts as well as an increase in infection rates and diminished renal function, according to a presentation here at the American College of Surgeons (ACS) 94th Annual Clinical Congress. The expanded criteria implemented to help deal with the shortage of organs allow for inclusion of organ donors who are older, have hypertension, or have history of stroke. Lead author Robert Stratta MD, General Surgery and Transplant Surgery, Wake Forest University Health Sciences, Winston Salem, North Carolina, presented the study on October 14. Dr. Stratta and colleagues conducted a retrospective review of current kidney transplants at their institution with a minimum follow-up of 7 months. They defined expanded-criteria donors as those deceased donors aged 60 years or older or donors aged 50 to 59 years with any 2 of the following criteria: history of hypertension, mean serum creatinine >1.5 mg/dL, or cerebrovascular accident as cause of death. Standard-criteria donors were all those who did not fall under the expanded-criteria definition. All patients received rabbit antithymocyte globulin, alemtuzumab, or anti-interleukin-2 receptor induction. Maintenance therapy included mycophenolate mofetil with or without steroids and delayed tacrolimus. Dr. Stratta noted that virtually all the expanded-criteria kidneys had been refused by other transplant centres and many had been targeted for discard. The study followed 516 kidney transplants with a mean donor age of 62 years for expanded-criteria donors and 34 years for standard-criteria donors, Dr. Stratta said. Time of cold ischaemia for the organ was a mean of 24 hours for both groups. "If clearance is less than 40 mL/min, we refuse the kidney," Dr. Stratta said. He added, "We try to pick low-risk patients with low BMI [body mass index]." Mean donor ages were 62 +- 7 years in the expanded-criteria donors and 34 +- 15 years in the standard-criteria donors (P < .001). The donor BMI for the 2 groups was a mean of 26 and 24 kg/m2, respectively (P = .02). Cause of death was cerebrovascular accident in 68% and 22%, respectively (P < .001). Donation after cardiac death occurred in 5% and 14%, respectively (P < .001). History of hypertension was reported in 47% and 14% of donors, respectively (P < .001). Terminal creatinine levels were the same in the 2 groups. Recipients were a mean of 58 +- 10 years old in the expanded-criteria groups and 49 +- 13 years old in the standard-criteria group (P < .001). BMI was 25 and 27, respectively (P < .001). Retransplants occurred in 7% and 17%, respectively (P < .001). Mean wait times were similar in the 2 groups (22 and 28 months; P = .03). Men made up 48% and 55% of the 2 groups (P = .14). The 2 groups had the same proportions of African American and diabetic recipients. Recipients were followed for a mean of 36 months in each group (8-85 vs 8-86 months; P = NS). Survival for the recipients of expanded-criteria donor kidneys was 86% compared with 93% for standard-criteria organs (P = .01). At 5 years of follow-up, the death-censored actuarial survival was not statistically different for the 2 groups. Initial lengths of hospital stay were the same in the expanded-criteria and standard-criteria groups (8.0 vs 7.7 days; P = NS); acute rejection occurred in 15% and 18%, respectively (P = NS); major infections occurred in 34% and 25% (P = .035); re-operations were required in 20% and 18% (P = NS); and readmissions were required in 45% and 42% (P = NS). Rates of all viral infections were 13% and 9%, respectively (P = .18). The researchers concluded that a systematic approach based on age, nephron mass, and size matching between donor and recipient may improve the use of expanded-criteria donor kidneys and decrease waiting times for recipients willing to accept an expanded-criteria donor kidney. "It may be more appropriate to place an expanded-criteria kidney into a lower-risk elderly recipient," Dr. Stratta concluded. [Presentation title: Lessons Learned From 198 Expanded Criteria Donor Kidney Transplants. Session GS46] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.