The objective of the study was to determine if ECD kidney size has an impact on recipient 5-year patient and graft survival.

A retrospective review of donors aged 50 and above with pre-transplant biopsies during the years 2000-2010 was performed using data from a single organ procurement organization. Recipient data was obtained from an OPTN Standard Transplant Analysis and Research file for the same time period. Among 1691 biopsied kidneys from donors aged 50 and above, 1027 were transplanted and 664 (40%) were discarded. Five-year patient and graft survival was 75% and 65%. To evaluate the donor and recipient factors that influence graft survival, we performed a multivariate analysis including 700 transplanted kidneys with complete information including a serum creatinine at one year. Small kidneys were defined as less than 10.5cm in length, medium sized kidneys were defined as 10.5 to 13cm, and large kidneys were defined as greater than 13cm.

Patients with a serum creatinine ≥ 2 mg/dl one year post transplant had a univariate hazard ratio (HR) for 5 year patient survival of 1.8 (p 0.008) and graft failure of 3.7 (p<0.001). Multivariate analysis of recipient and donor factors is shown.

Conclusion: Size was not a significant factor for patient or graft survival in recipients of kidney transplants from donors over age 50. The only donor factor that showed a decreased chance of a serum creatinine ≥ 2 mg/dl one year after transplant was a BMI of less than 25. Recipient male gender, and diabetes are significant risk factors for a serum creatinine of more than 2 mg/dl. An elevated creatinine at one year following transplant in recipients of ECD kidneys is a significant risk factor for patient and graft survival.

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