Studies of Expanded Criteria Donor (ECD) kidney (K) transplantation confirm lower allograft survival compared to Standard Criteria Donor (SCD)and donor age has been strongly implicated as risk factor. Graft outcomes of recipients (R) of SCD kidneys with risk factors of ECD are poorly understood and hence were studied.

Among adult deceased donor K R from UNOS database, 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 were identified as ECD40sR and ECD30sR respectively. Control groups were ECDR and SCDR. Excluded were re transplant, dual and multi-organ transplant R. Median follow up was 4 years. Kaplan Meier survival and Cox regression analyses for graft survival (GS) were performed to compare ECD40sR and ECD30sR with ECDR and SCDR. The variables used for Cox regression analysis were: Recipient: Age, race, gender, BMI, cause of ESRD, comorbidities- hypertension, diabetes, cardiovascular disease, peripheral vascular disease, cerebrovascular disease, OPO wait time, preemptive transplantation, duration of HD. Donor: Age, race, gender, hypertension, donor/recipient HLA mismatch, ischemia times, delayed graft function, acute rejection. Graft failutre was defined as retransplantation or return to dialysis and censored for death.

Results: On Kaplan Meier survival analysis, GS appeared to be significantly superior for ECD40sR and ECD30sR compared to ECDR. However, on Cox regression analysis, there appeared to be no difference in graft survival after adjusting for all study variables.

When compared with SCDR, ECD40sR and ECD30sR appeared to have decreased GS on both Kaplan Meier and Cox regression analyses regardless of other study variables, 11% and 16% lower GS respectively.

There appeared to be no GS benefit for recipients receiving ECD like SCD kidneys. These organs given as SCD kidneys had inferior GS compared to SCD K. It appears that hypertension and or CVA (correlate of hypertension) and not donor age seems to determine graft failure risk. Whether there is concordance with Kidney Donor Risk Index and Kidney Donor Profile Index remains to be seen and is being analyzed.

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