Introduction: Expanded criteria donor (ECD) kidneys increase the organ pool but their discard rate remains high, especially in the setting of donation after cardiac death (DCD). Some centers consider DCD/ECDs a contraindication to kidney transplant (KT) because of the “dual hit” of requisite warm ischemic injury in a kidney with estimated lower nephron mass from pre-existing abnormalities. Consequently, the value of using these kidneys has been questioned. The study purpose was to analyze our experience with KT recipients from DCD donors stratified by ECD vs non-ECD (standard criteria donor [SCD]) KTs. METHODS: Single center retrospective review of DCD KT recipients. Standardized management algorithms used to preserve nephron function and recipient selection based on low immunological risk, predicted limited nephron need and informed consent. All patients (pts) received depleting antibody induction with tacrolimus/mycophenolate ± steroids. RESULTS: From 2006 – 2016 we performed 273 primary DCD KTs; 228 DCD/SCDs and 45 DCD/ECDs. Mean donor age, BMI, terminal serum creatinine and Kidney Donor Profile Index values between DCD/SCD and DCD/ECD KTs were 38 vs 59 yrs (p<0.05), 28 vs 32 kg/m² (NS), 0.9 vs 1.0 mg/dl (NS), and 49% vs 85% (p<0.05), respectively. Mean warm ischemia and cold ischemia time between groups were 25 vs 32 min (NS) and 28 vs 25 hrs (NS), respectively. There were 12 (5%) DCD/SCD dual KTs vs 6 (13%) DCD/ECD dual KTs (p<0.05). Mean pt age, BMI and wait time between DCD/SCD and DCD/ECD KTs were 52 vs 62 yrs (p<0.05), 29 vs 27 kg/m² (NS), and 25 vs 17 months (NS), respectively. Overall mean pt PRA was 13% (NS between groups). With a mean follow-up of 4 years, pt survival (PS, 86% DCD/SCD vs 76% DCD/ECD, p=0.07) and kidney graft survival (GS, 68% DCD/SCD vs 64% DCD/ECD, NS) rates were comparable. 1-year PS rates were 96% in both groups, with 1-year GS rates of 89% DCD/SCD vs 84% DCD/ECD (NS). Rates of primary non-function were 4.4% DCD/SCD vs 2.2% DCD/ECD (NS) and rates of delayed graft function were 54% DCD/SCD vs 60% DCD/ECD (NS). CONCLUSION: With appropriate donor and pt selection, acceptable intermediate-term outcomes can be achieved with kidneys from DCD/ECDs compared to DCD/SCDs. Based on this experience, we recommend judicious use of kidneys from DCD/ECDs as a method to safely expand the limited donor pool.

CITATION INFORMATION: Harriman D., Rogers J., Farney A., Orlando G., Reeves-Daniel A., Gautreaux M., Doares W., Kaczmorski S., Stratta R. Should Kidneys from Donation after Cardiac Death Expanded Criteria Donors Be Transplanted? Am J Transplant. 2017;17 (suppl 3).

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