Most studies of Expanded Criteria Donor (ECD) kidney (K) transplantation confirm that recipients(R) of ECD K have improved survival compared with matched dialysis-treated patients. However, ECD K were significant predictors of mortality in non elderly patients. Outcomes of recipients (R) of Standard Criteria Donor (SCD) K with risk factors of ECD are unknown and were studied.

Among adult deceased donor K R from UNOS database from 1995 to 2010, we identified those R whose donors were 40-49 and 30-39 years of age and met 2 of the 3 ECD criteria: history of hypertension, serum creatinine of >1.5 mg/dl and who died of CVA. We referred to these as ECD40sR and ECD30sR respectively. Control groups were ECDR and SCDR. Excluded were re transplants, dual and multi-organ transplant R. Median follow up was 4 years. Kaplan Meier survival and Cox regression analyses for patient survival (PS) were performed to compare ECD40sR, and ECD30sR with ECDR and SCDR. The variables for comparative and Cox regression analysis were: Recipient: Demographics, BMI, cause of ESRD, comorbidities- hypertension, diabetes, cardiac and vascular disease, OPO waiting time, duration of HD. Donor: Demographics, hypertension, donor/recipient HLA mismatch, ischemia times. Orher: delayed graft function, acute rejection.

Results: On Kaplan Meier survival analysis PS appeared to be significantly superior for ECD40sR and ECD30sR compared to ECDR. However, on Cox regression analysis, there appeared to be no difference in patient survival.

On both Kaplan Meier and Cox regression analysis, there appeared to be marginally albeit significantly increased mortality in ECD40sR compared to SCDR; no difference in survival noted between SCDR and ECD30sR.

There appeared to be no PS benefit for R of ECD30s or ECD40s kidneys, these organs are currently allocated as SCD organs (with the expectation of a survival benefit of SCD transplantation). Whether this is due to predetermined center related patient selection bias at the time of organ offer can be explored by analysis of center specific data. Correlation with Kidney Donor Risk Index and Kidney Donor Profile Index is underway.

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