The Expanded Criteria Donors The Expanded Criteria Donors in Kidney Transplantation: in Kidney Transplantation:

3 Years Experience 2008 - 20103 Years Experience 2008 - 2010

FAM Shaheen, B. Al-Attar, MZ Souqiyyeh, J.E Cillo, A. Al Sayyari

Saudi Center For Organ Transplantation,Riyadh, Kingdom of Saudi Arabia

Kidney Transplantation is the preferred therapy for most patients with ESRD and is superior to dialysis in terms of long term mortality risk.

The poll of renal transplant candidates has increased dramatically.

There is a significant need for kidneys from deceased donors.

IntroductionIntroduction

ObjectivesObjectives

Identify and analyze the use of Expanded Criteria Donor Kidneys.

The outcome of kidney transplantation in Saudi Arabia.

MethodsMethods

A retrospective study of all deceased donor

transplantation carried out from the year 2008 –

2010. Investigating the impact on graft and patient

survival and graft function of Expanded Criteria

Donor Kidneys compared to Standard Criteria

Donors (SCD).  

ResultsResults

No. of Consented DD

No. of Retrieved DDFor Kidneys

No. of Retrieved Kidneys

No. of Transplanted

Kidneys

314 225 461* 432 (94%) *

Donor Characteristic:

•Age ≥ 60y.o

•Age 50 – 59y.o / CVA / HTN and or S. Cr ≥ 133 µmol/L ( 1.5 mg/dl ) •CVA / HTN / S. Cr doubled at harvesting

ECD SCD

68(16%) 364 (84%)

TOTAL - 432 Kidneys

Note: 2 transplanted Kidneys from HCV positive donor

7 Kidneys

43 Kidneys

18 Kidneys

SCD = Standard Criteria DonorsECD = Expanded Criteria Donors

ResultsResults

Donor Characteristics

Total - 225 Donors

Donor Characteristics P-Value

Factors All Donors SCD ECD

Mean Age 37 ± 11.4 (3m – 71) years

39 years 48 years < 0.0001

Males 90% 90% 89% NS

Traumatic 49 % 38 % .02% < 0.0001

Mean Period from

Admission to Harvesting

8

(2-35) days

8

(2-35) days

8

(2-16) days

NS

Mean Scr. on Admission

112 µmol/L 106 µmol/L 143 µmol/L NS

Mean Scr. at Harvesting

145 µmol/L 129 µmol/L 224 µmol/L 0.033

ResultsResults

Recipient CharacteristicsRecipient Characteristics P-Value

Factor All Recipients SCD ECD

Mean Age 35 (2 -77) yrs 33 (2-77) yrs 46 (13-75) yrs 0.016

CIT 14.2

(2-46.32) hrs

14

(3.24-46.32) hrs

15

(3-30) hrs

NS

Mean Period from Tx. To Discharge

21.9 (4-535) days

19 (4-535)

days

32 (6-127) days NS

Mean Scr. at Discharge

183 µmol/L 153 µmol/L 261 µmol/L 0.0049

Delayed Graft Function

19.7 % 14 % 31 % 0.002

Episode of Acute Rejection

8 % 3 % 16 % 0.001

Death before Discharge

2 NIL 2 -

ResultsResults

Patient Follow-up 2008 - 2010

Kidney Type, No. / % Status

430 Total Kidney Recipients / 100%

365 SCD Kidney

Recipients / 100%

68 ECD Kidney Recipients /

100%

Graft is Active 380 / 80% 329 / 90% 57 / 84%

Graft is Loss 6 / 1% 4 / 1% 2 / 3%

Patient Loss Follow up

10 / 2% 7 / 2% 3 / 4%

Patient Died 12 / 3% 7 / 3% 4 / 6%

Total: 408 / 95% 347 / 96% 66 / 97%

ConclusionsConclusions

The use of marginal kidney donors is an

acceptable method to use in specified category of

patients on waiting list for kidney transplantation in

Saudi Arabia.

The outcome of marginal kidney transplantation is

comparable to international data.