All Expanded Criteria Donor Kidneys are Equal But are Some More Equal Than Others? A Population-Cohort Analysis of UK Transplant Registry Data

• Published in: Transplant international 2023-09, Vol.36, p.11421-11421
• Main Authors: Patel, Kamlesh, Brotherton, Anna, Chaudhry, Daoud, Evison, Felicity, Nieto, Thomas, Dabare, Dilan, Sharif, Adnan
• Format: Article
• Language: English
• Subjects: Health Archive
• ISSN: 1432-2277; 0934-0874; 1432-2277
• DOI: 10.3389/ti.2023.11421

Survival outcomes for kidney transplant candidates based on expanded criteria donor (ECD) kidney type is unknown. A retrospective cohort study was undertaken of prospectively collected registry data of all waitlisted kidney failure patients receiving dialysis in the United Kingdom. All patients listed for their first kidney-alone transplant between 2000–2019 were included. Treatment types included; living donor; standard criteria donor (SCD); ECD 60 (deceased donor aged ≥60 years); ECD 50–59 (deceased donor aged 50–59 years with two from the following three; hypertension; raised creatinine and/or death from stroke) or remains on dialysis. The primary outcome was all-cause mortality, with time-to-death from listing analyzed using time-dependent non-proportional Cox regression models. The study cohort comprised 47,917 waitlisted kidney failure patients, of whom 34,558 (72.1%) received kidney transplantation. ECD kidneys ( n = 7,356) were stratified as ECD 60 ( n = 7,009) or ECD 50–59 ( n = 347). Compared to SCD, both ECD 60 (Hazard Ratio 1.126, 95% CI 1.093–1.161) and ECD 50–59 (Hazard Ratio 1.228, 95% CI 1.113–1.356) kidney recipients have higher all-cause mortality. However, compared to dialysis, both ECD 60 (Hazard Ratio 0.194, 95% CI 0.187–0.201) and ECD 50–59 (Hazard Ratio 0.218, 95% CI 0.197–0.241) kidney recipients have lower all-cause mortality. ECD kidneys, regardless of definition, provide equivalent and superior survival benefits in comparison to remaining waitlisted.