With the new Kidney Allocation System, broader sharing of expanded criteria donor (ECD) kidneys may occur, which may influence discard rates and survival outcomes. To better understand the benefits and risks of importing ECD kidneys, we retrospectively reviewed our single center experience with ECD kidney transplants (KT) according to donor location. Methods: All patients (pts) received depleting antibody induction with FK/MPA ± steroids. Standardized management algorithms were implemented to preserve nephron function (including machine preservation) and pt selection was based on low immunologic risk, older age and predicted limited nephron need. Results: Over a 12.8 year period, we performed 497 ECD KTs including 247 local and 250 imported from other donor service areas. The import ECD group had more donors (16% vs 8.5%) and recipients (23% vs 16%) ≥ age 70, more zero HLA-mismatches (14% vs 2%), more pts with a PRA >20% (17% vs 9%), more KTs with a cold ischemia time >30 hours (46% vs 19%), fewer DCD/ECDs (5% vs 9%), higher pump resistance (mean 0.27 vs 0.20 mm Hg/ml/min) and fewer kidneys managed with pump preservation (78% vs 92%, all p ≤ 0.05) compared to the local ECD group. The 2 groups were comparable in terms of other characteristics such as donor renal function and cause of death, donor and recipient gender and ethnicity, dialysis modality, waiting time, kidney laterality, as well as proportion of dual KTs (10% import vs 12% local) and retransplants (6% import vs 3% local). 271 pts (54.5%) had at least 5 years follow-up. With mean follow-up of 55 months, actual pt and graft survival rates were 71% and 57.6% in import vs 76% and 57.9% in local ECD KTs, respectively. Death-censored graft survival rates were 70% in import vs 69% in local ECD KTs. Delayed graft function occurred in 28% import vs 23% (p=NS) local ECD KTs. There were no differences in other outcomes. 1- and 2-year renal function (eGFR 42 ml/min/1.73 m²) was similar in both groups. Conclusions: Mid-term outcomes are similar for import vs local ECD KTs, suggesting that broader sharing of ECD kidneys may improve utilization without compromising outcomes.

CITATION INFORMATION: Khan M, El-Hennawy H, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Gautreaux M, Iskandar S, Doares W, Kaczmorski S, Stratta R. Analysis of Local versus Imported Expanded Criteria Donor (ECD) Kidneys: A Single Center Experience with 497 ECD Kidney Transplants. Am J Transplant. 2016;16 (suppl 3).

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