Background: Use of grafts from expanded criteria donors (ECD) has increased significantly in recent years. Acceptable reported outcomes may increase the limits of acceptance and decrease the discard rate.

Objective: To analyze characteristics and outcomes of expanded criteria deceased donor (ECD) kidney transplants.

Methods: Retrospective cohort study analyzed 372 recipients from 272 ECDs, transplanted between 1998 and 2009 (382 kidneys transplanted in the institution – 10 recipients excluded due to of loss of follow-up; 144 kidneys transplanted elsewhere; 18 kidneys discarded). All recipients received single kidney transplants. The findings of preimplantation biopsy, performed in 233 (62%) of the kidneys, were reclassified according to a severity-based score used previously by Remuzzi et al (2006). Primary endpoints were recipient, graft and death-censored graft survivals at 6 and 36 months posttransplant.

Results: ECD had a mean age of 58 years old, 70% were hypertensive, stroke being the main cause of death, and the final mean creatinine was 1.7 mg/dL. Pretransplant histological evaluation of transplanted kidneys showed that 38% had a final ranking of “moderate changes” and 17% of “severe changes”. Recipients had a mean age of 49 years, hypertension (17%) and diabetes mellitus (16%) as the main cause of chronic renal failure, mean time on dialysis of 56 months, PRA < 50% in 94%, first transplant in 94%. Mean cold ischemia time was 25 hours. Patient and graft survival rates at 6 months and 3 years were, respectively, 91.6% and 81%, 85.3% and 68.9%. Improved graft survival at 3 years was observed among transplants performed between 2007 and 2009 compared to those between 1998 and 2006 (70.4% vs. 61.4%). Graft survival at 3-years was negatively associated to the severity of pretransplant histological score (78% for mild changes, 72% for moderate changes and 60% for severe changes, p=0.016). Multivariable analysis, however, found recipient history of Diabetes the only independent risk factor for graft loss (OR 2.1, CI 1.3-3.3, p=0.003) and recipient death (OR 3.1, CI 1.6-5.8, p<0.001).

Conclusions: Results of this study indicate reasonable long-term survival for ECD single kidneys transplants, and point to improvements over time. Severity of histological changes was not an independent risk factor for inferior outcomes. Diabetes was the one independent risk factor associated with patient and graft survival.

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