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.
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