The increasing shortage of donor kidneys available for transplantation combined with an ageing population has resulted in the use of expanded-criteria donor (ECD) kidneys. These kidneys are associated with an increased risk of delayed graft function, acute rejection and reduced graft survival. This paper will cover the use of ECDs and the presentation of risk to patients receiving these organs.
Get full access to this article
View all access options for this article.
References
1.
WolfeRA, AshbyVB, MilfordEL, Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med1999;341:1725–30
2.
OjoAO, HansonJA, Meier-KriescheH, Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol2001;12:589–97
3.
EvansRW, ManninenDL, GarrisonLPJr, The quality of life of patients with end-stage renal disease. N Engl J Med1985;312:553–9
4.
TransplantUK. Transplant Activity in the UK: Activity Report 2009/10. London: NHS Blood and Transplant, 2010
5.
GastonRS, DanovitchGM, AdamsPL, The report of a national conference on the wait list for kidney transplantation. Am J Transplant2003;3:775–85
6.
Eurotransplant. 2010. See http://www.eurotransplant.org/cms/mediaobject.php?file=ar_2010.pdf (last checked 29 June 2011)
7.
Network USOPaT. 2009. See http://optn.transplant.hrsa.gov/ar2009/ (last checked 29 June 2011)
8.
9.
KauffmanH, BennettL, McBrideM, EllisonM. The expanded donor. Transplant Rev1997;11:165–90
10.
PortFK, Bragg-GreshamJL, MetzgerRA, Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation2002;74:1281–6
11.
WhitingJF. Clinical and economic outcomes of the use of expanded criteria donors in renal transplantation. Semin Dial2000;13:316–9
12.
VivasCA, HickeyDP, JordanML, Renal transplantation in patients 65 years old or older. J Urol1992;147:990–3
13.
MascarettiL, PappaletteraM, GravameV, ChieccaR, ScalamognaM, SirchiaG. Cadaver kidney transplantation using donors with hypertension in the North Italy Transplant program. Transplant Proc1990;22:382
14.
LeeCM, ScandlingJD, ShenGK, SalvatierraO, DafoeDC, AlfreyEJ. The kidneys that nobody wanted: support for the utilization of expanded criteria donors. Transplantation1996;62:1832–41
15.
GolcondaMS, WhitingJF, SmithR, HayesR, AlexanderJW, FirstMR. Long-term outcome of kidney transplantation from expanded criteria donors: a single center experience. Transplant Proc1997;29:3379–81
16.
StrattaRJ, RohrMS, SundbergAK, Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant. Ann Surg2004;239:688–95; discussion 95–7
17.
DahmaneD, AudardV, HiesseC, Retrospective follow-up of transplantation of kidneys from ‘marginal’ donors. Kidney Int2006;69:546–52
18.
KeitelE, MichelonT, dos SantosAF, Renal transplants using expanded cadaver donor criteria. Ann Transplant2004;9:23–4
19.
LeeCM, CarterJT, WeinsteinRJ, Dual kidney transplantation: older donors for older recipients. J Am Coll Surg1999;189:82–91; discussion 2
20.
TanJC, AlfreyEJ, DafoeDC, MillanMT, ScandlingJD. Dual-kidney transplantation with organs from expanded criteria donors: a long-term follow-up. Transplantation2004;78:692–6
21.
MatasAJ, GillinghamK, PayneWD, Should I accept this kidney?Clin Transplant2000;14:90–5
22.
CosioFG, HenryM, PesaventoTE, FergusonRM, KimS, LemeshowS. The relationship between donor age and cadaveric renal allograft survival is modified by the recipient's blood pressure. Am J Transplant2003;3:340–7
23.
FoleyDP, PattonPR, Meier-KriescheHU, Long-term outcomes of kidney transplantation in recipients 60 years of age and older at the University of Florida. Clin Transpl2005:101–9
24.
MoresoF, SeronD, Gil-VernetS, Donor age and delayed graft function as predictors of renal allograft survival in rejection-free patients. Nephrol Dial Transplant1999;14:930–5
25.
WaiserJ, SchreiberM, BuddeK, Age-matching in renal transplantation. Nephrol Dial Transplant2000;15:696–700
26.
de FijterJW, MallatMJ, DoxiadisII, Increased immunogenicity and cause of graft loss of old donor kidneys. J Am Soc Nephrol2001;12:1538–46
27.
LovenC, NordenG, NybergG. Impact of cadaveric renal donor morbidity on long-term graft function. Transpl Int2003;16:857–60
28.
FabriziiV, WinkelmayerWC, KlauserR, Patient and graft survival in older kidney transplant recipients: does age matter?J Am Soc Nephrol2004;15:1052–60
29.
BertoniE, RosatiA, ZanazziM, Excellent outcome of renal transplantation using single old kidneys in old recipients. Ann Transplant2004;9:25–6
30.
FossA, TuvinD, LeivestadT, OyenO, BentdalO. Should kidneys from older cadaveric donors be age-matched to the recipient?Transplant Proc2005;37:3280–2
31.
MessaP, BrezziB, CresseriD, Immediate graft function positively affects long-term outcome of renal allografts from older but not from younger donors. Transplant Proc2006;38:3377–81
32.
CicciarelliJ, IwakiY, MendezR. The influence of donor age on kidney graft survival in the 1990s. Clin Transpl1999:335–40
33.
CarterJT, LeeCM, WeinsteinRJ, LuAD, DafoeDC, AlfreyEJ. Evaluation of the older cadaveric kidney donor: the impact of donor hypertension and creatinine clearance on graft performance and survival. Transplantation2000;70:765–71
34.
KasiskeBL, SnyderJ. Matching older kidneys with older patients does not improve allograft survival. J Am Soc Nephrol2002;13:1067–72
35.
Meier-KriescheHU, CibrikDM, OjoAO, Interaction between donor and recipient age in determining the risk of chronic renal allograft failure. J Am Geriatr Soc2002;50:14–7
36.
CeckaJM. The UNOS Renal Transplant Registry. Clin Transpl2002:1–20
37.
MandalAK, SnyderJJ, GilbertsonDT, CollinsAJ, SilkensenJR. Does cadaveric donor renal transplantation ever provide better outcomes than live-donor renal transplantation?Transplantation2003;75:494–500
38.
SchnitzlerMA, WhitingJF, BrennanDC, The expanded criteria donor dilemma in cadaveric renal transplantation. Transplantation2003;75:1940–5
39.
KeithDS, DemattosA, GolcondaM, PratherJ, NormanD. Effect of donor recipient age match on survival after first deceased donor renal transplantation. J Am Soc Nephrol2004;15:1086–91
40.
GjertsonDW. Explainable variation in renal transplant outcomes: a comparison of standard and expanded criteria donors. Clin Transpl2004:303–14
41.
CeckaJM. The OPTN/UNOS Renal Transplant Registry. Clin Transpl2005:1–16
42.
MerionRM, AshbyVB, WolfeRA, Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA2005;294:2726–33
43.
OppenheimerF, AljamaP, Asensio PeinadoC, Bustamante BustamanteJ, Crespo AlbiachJF, Guirado PerichL. The impact of donor age on the results of renal transplantation. Nephrol Dial Transplant2004;19(Suppl 3):iii11–5
44.
DanovitchGM, CohenDJ, WeirMR, Current status of kidney and pancreas transplantation in the United States, 1994–2003. Am J Transplant2005;5(Part 2):904–15
45.
United Nations Programme on Aging. United Nations; 2010; See http://www.un.org/ageing/popageing.html (last checked 26 June 2011)
46.
HansberryMR, WhittierWL, KrauseMW. The elderly patient with chronic kidney disease. Adv Chronic Kidney Dis2005;12:71–7
47.
DanovitchG, SavranskyE. Challenges in the counseling and management of older kidney transplant candidates. Am J Kidney Dis2006;47(Suppl 2):S86–97
48.
OniscuGC, BrownH, ForsytheJL. How great is the survival advantage of transplantation over dialysis in elderly patients?Nephrol Dial Transplant2004;19:945–51
49.
US Renal Data System. In: Health NIo, ed. USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 2008
50.
Meier-KriescheHU, KaplanB. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation2002;74:1377–81
51.
GillJS, TonelliM, JohnsonN, KiberdB, LandsbergD, PereiraBJ. The impact of waiting time and comorbid conditions on the survival benefit of kidney transplantation. Kidney Int2005;68:2345–51
52.
OPTN: Waiting List by Organs as of January 18th 2010.2010. See http://optn.transplant.hrsa.gov/ar2009/502_age_ki.htm (last checked 18 January 2010)
53.
GillJ, BunnapradistS, DanovitchGM, GjertsonD, GillJS, CeckaM. Outcomes of kidney transplantation from older living donors to older recipients. Am J Kidney Dis2008;52:541–52
54.
BT N. 2010 [29.06.2011]; See http://www.organdonation.nhs.uk/ukt/how_to_become_a_donor/living_kidney_donation/living_kidney_donation.jsp (last checked 29 June 2011)
55.
MandelbrotDA, PavlakisM, DanovitchGM, The medical evaluation of living kidney donors: a survey of US transplant centers. Am J Transplant2007;7:2333–43
56.
Fehrman-EkholmI, ElinderCG, StenbeckM, TydenG, GrothCG. Kidney donors live longer. Transplantation1997;64:976–8
57.
EllisonMD, McBrideMA, TarantoSE, DelmonicoFL, KauffmanHM. Living kidney donors in need of kidney transplants: a report from the organ procurement and transplantation network. Transplantation2002;74:1349–51
58.
GibneyEM, KingAL, MalufDG, GargAX, ParikhCR. Living kidney donors requiring transplantation: focus on African Americans. Transplantation2007;84:647–9
BayWH, HebertLA. The living donor in kidney transplantation. Ann Intern Med1987;106:719–27
61.
NajarianJS, ChaversBM, McHughLE, MatasAJ. 20 years or more of follow-up of living kidney donors. Lancet1992;340:807–10
62.
RamcharanT, MatasAJ. Long-term (20–37 years) follow-up of living kidney donors. Am J Transplant2002;2:959–64
63.
IbrahimHN, RogersT, TelloA, MatasA. The performance of three serum creatinine-based formulas in estimating GFR in former kidney donors. Am J Transplant2006;6:1479–85
64.
IbrahimHN, FoleyR, TanL, Long-term consequences of kidney donation. N Engl J Med2009;360:459–69
65.
CohenB, SmitsJM, HaaseB, PersijnG, VanrenterghemY, FreiU. Expanding the donor pool to increase renal transplantation. Nephrol Dial Transplant2005;20:34–41
66.
SchlieperG, IvensK, VoiculescuA, LutherB, SandmannW, GrabenseeB. Eurotransplant Senior Program ‘old for old’: results from 10 patients. Clin Transplant2001;15:100–5
67.
JassalSV, KrahnMD, NaglieG, Kidney transplantation in the elderly: a decision analysis. J Am Soc Nephrol2003;14:187–96
68.
KasiskeBL, CangroCB, HariharanS, The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant2001;1(Suppl 2):3–95
69.
DanovitchGM, CeckaJM. Allocation of deceased donor kidneys: past, present, and future. Am J Kidney Dis2003;42:882–90
70.
WigmoreSJ, SeeneyFM, PleassHC, PraseedomRK, ForsytheJL. Kidney damage during organ retrieval: data from UK National Transplant Database. Kidney Advisory Group. Lancet1999;354:1143–6
71.
BentasW, ProbstM, JonesJ, [Quality of kidney procurement in Germany. Ten years experience and 486 renal allografts in a single centre]. Urologe A2007;46:268–70, 71–3
72.
ScholdJD, KaplanB, BaligaRS, Meier-KriescheHU. The broad spectrum of quality in deceased donor kidneys. Am J Transplant2005;5(Part 1):757–65
73.
Meier-KriescheH-U, ColeE, ScholdJ, PattonP, HowardR, KaplanB. Analysis of the expanded criteria donor kidneys: How good is your ECD going to be?Am J Transplant2004;4(Supp 8):305
74.
JohnstonO, O'KellyP, SpencerS, The impact of donor spontaneous intracranial haemorrhage vs. other donors on long-term renal graft and patient survival. Clin Transplant2006;20:91–5
75.
PessioneF, CohenS, DurandD, Multivariate analysis of donor risk factors for graft survival in kidney transplantation. Transplantation2003;75:361–7
76.
LeeCM, CarterJT, RandallHB, The effect of age and prolonged cold ischemia times on the national allocation of cadaveric renal allografts. J Surg Res2000;91:83–8
77.
RemuzziG, GrinyoJ, RuggenentiP, Early experience with dual kidney transplantation in adults using expanded donor criteria. Double Kidney Transplant Group (DKG). J Am Soc Nephrol1999;10:2591–8
78.
RemuzziG, CravediP, PernaA, Long-term outcome of renal transplantation from older donors. N Engl J Med2006;354:343–52
79.
MuruveNA, SteinbeckerKM, LugerAM. Are wedge biopsies of cadaveric kidneys obtained at procurement reliable?Transplantation2000;69:2384–8
80.
NybergSL, MatasAJ, KremersWK, Improved scoring system to assess adult donors for cadaver renal transplantation. Am J Transplant2003;3:715–21
81.
Baskin-BeyES, KremersW, NybergSL. A recipient risk score for deceased donor renal allocation. Am J Kidney Dis2007;49:284–93
82.
Baskin-BeyES, NybergSL. Matching graft to recipient by predicted survival: can this be an acceptable strategy to improve utilization of deceased donor kidneys?Transplant Rev (Orlando)2008;22:167–70
83.
BraunWE. Every kidney counts. N Engl J Med1992;327:883–5
84.
DanovitchGM, CohenB, SmitsJM. Waiting time or wasted time? The case for using time on dialysis to determine waiting time in the allocation of cadaveric kidneys. Am J Transplant2002;2:891–3
85.
Baskin-BeyES, KremersW, NybergSL. Improving utilization of deceased donor kidneys by matching recipient and graft survival. Transplantation2006;82:10–4
JochmansI, MoersC, SmitsJM, Machine perfusion versus cold storage for the preservation of kidneys donated after cardiac death: a multicenter, randomized, controlled trial. Ann Surg2010;252:756–64
88.
MoersC, SmitsJM, MaathuisMH, Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med2009;360:7–19
89.
WolfeRA, McCulloughKP, SchaubelDE, Calculating life years from transplant (LYFT): methods for kidney and kidney-pancreas candidates. Am J Transplant2008;8(Part 2):997–1011
90.
GeddesCC, RodgerRS, SmithC, GanaiA. Allocation of deceased donor kidneys for transplantation: opinions of patients with CKD. Am J Kidney Dis2005;46:949–56
91.
SuX, ZeniosSA, ChertowGM. Incorporating recipient choice in kidney transplantation. J Am Soc Nephrol2004;15:1656–63
92.
RudowDL. The living donor advocate: a team approach to educate, evaluate, and manage donors across the continuum. Prog Transplant2009;19:64–70
93.
RudowDL, BrownRSJr. Role of the independent donor advocacy team in ethical decision making. Prog Transplant2005;15:298–302
