ECD for Kidney Transplantation

  • Naoto Matsuno


Because of the shortage of organs for kidney transplantation, there has been greater interest in recent years in the use of expanded criteria donors (ECDs), defined as brain-dead donors aged ³60 years or donors aged ³50 years with a history of hypertension plus terminal donor serum creatinine £1.5mg/dL, or death resulting from a cerebrovascular accident. Although long-term outcomes of ECD kidneys has been worse than that of standard-criteria donor kidneys, mortality is decreased with ECD kidney transplant compared with remaining on dialysis therapy. This review focuses on the use of ECDs to define donor and recipient selection criteria, including the usefulness of donor kidney biopsies as a pretransplant test for dual kidney transplantation. In addition, short- and long-term survival for younger and older patients who received ECD kidney transplantation compared with remaining on dialysis therapy is reviewed.


Human Leukocyte Antigen Graft Survival Graft Loss Donor Kidney Delay Graft Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    United Network for Organ Sharing. United Network for Organ Sharing 1999 Annual report of the U.S. Scientific registry for Transplant recipients and the Organ and Transplantation Network, UNOS, Richmond, 1999.Google Scholar
  2. 2.
    Giral-Classe M, Homant M, Cantarovich D, et al. Delayed graft function of more than six days strongly decreases long-term survival of transplanted kidneys. Kidney Int. 1998;54:972.PubMedCrossRefGoogle Scholar
  3. 3.
    Hariharan S, Johnson CP, Bresnahan BA, et al. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342:605.PubMedCrossRefGoogle Scholar
  4. 4.
    Chertow G, Brenner BM, Mackenzie HS, Milford EL. Non-immunologic predictors of chronic renal allograft failure: data from the United network of Organ sharing. Kidney Int Suppl. 1995;52:48.Google Scholar
  5. 5.
    Hariharan S, McBride MA, Bennett LE, Cohen EP. Risk factors for renal allograft survival from older cadaver donors. Transplantation. 1997;64:174.CrossRefGoogle Scholar
  6. 6.
    Mirza DF, Gunson BK, DaSilva RF, Mayer AD, Bucke JA, McMaster P. Policies in Europe on 'marginal quality' donor livers. Lancet. 1994;1:1480.CrossRefGoogle Scholar
  7. 7.
    Detre KM, Lombadero M, Belle S, et al. Influence of donor age on graft survival after liver transplantation- United network for Organ Sharing Registry. Liver Transplant Surg. 1995;1:311.CrossRefGoogle Scholar
  8. 8.
    Tuttle-Newhall JE, Krishnan SM, Levy MF, et al. Organ donation and utilization in the United States; 1998–2007. Am J Transplantation. 2009;9:879–93.CrossRefGoogle Scholar
  9. 9.
    Port FK, Bragg-Gresham JL, Metzger RA, et al. Donor characteristics associated with reduced graft survival: An approach to expanding the pool of kidney donors. Transplantation. 2002;74:1281–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Metzger RA, Delmonico FL, Feng S, Port FK, Wynn JJ, Merion RM. Expanded criteria donors for kidney transplantation. Am J Transplant. 2003;125 Suppl 4:3S–114.Google Scholar
  11. 11.
    Lloveras J, Arias M, Andres A, et al. Five-year follow-up of 250 recipients of cadaveric kidney allografts from donors older than 55 years of age. Transplant Proc. 1995;27:981.PubMedGoogle Scholar
  12. 12.
    Frei U, Schindler R, Wieters D, et al. Pre-transplant hypertension: a major risk factor for chronic progressive renal allograft dysfunction. Nephrol Dial Transplant. 1995;10:1206.PubMedGoogle Scholar
  13. 13.
    Schold JD, Kaplan B, Baliga RS, Meier-Kriesche HU. The broad spectrum of quality in deceased donor kidneys. Am J Transplant. 2005;5:757–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Escofet X, Osman H, Griffiths DF, Woydag S, Adam Jurewicz W. The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation. Transplantation. 2003;75:344–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Nyberg SL, Matas AJ, Rogers M, et al. Donor scoring system for cadaveric renal transplantation. Am J Transplant. 2001;1:162–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Nyberg SL, Matas AJ, Kremers WK, et al. Improved scoring system to assess adult donors for cadaver renal transplantation. Am J Transplant. 2003;3:715–25.PubMedCrossRefGoogle Scholar
  17. 17.
    Rao PS, Schaubel DE, Guidnrger MK, et al. A comprehensive risk quantification score for discarded donor kidneys: the kidney donor risk index. Transplantation. 2009;88:231–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Anglicheau D, Loupy A, Lefaucheur C, et al. A simple clinico-histopathological composite scoring system is highly predictive of graft outcomes in marginal donors. Am J Transplant. 2008;8:2325.PubMedCrossRefGoogle Scholar
  19. 19.
    Remuzzi G, Grinyo J, Ruggenenti P, et al. Early experience with dual kidney transplantation in adults using expanded donor criteria. J Am Soc Nephrol. 1999;1:2591–8.Google Scholar
  20. 20.
    Andres A, Morales JM, Herrer JC, et al. Double versus single renal allografts from aged donor. Transplantation. 2000;69:2000–1.CrossRefGoogle Scholar
  21. 21.
    Navaro MD, Lopez-Andreu M, Radrigiez-Benot A, et al. Significance of preimplantation analysis of kidney biopsies from expanded criteria donors in long-term outcome. Transplantation. 2011;91(4):432–9.Google Scholar
  22. 22.
    Sung RS, Christensen LL, Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys: Impact of biopsy and machine perfusion. Am J Transplant. 2008;8:783–92.PubMedCrossRefGoogle Scholar
  23. 23.
    Edwards EB, Posner MP, Maluf DG, Kauffman HM. Reasons for non-use of recovered kidneys: the effect of donor glomerulosclerosis and creatinine clearance on graft survival. Transplantation. 2004;77:1411–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Kayler LK, Agliocca J, Zendejas I, et al. Impact of cold ischemia time on graft survival among ECD transplant recipients. A paired kidney analysis. Am J Transplant. 2011;11:2647–56.PubMedCrossRefGoogle Scholar
  25. 25.
    Sung RS, Guidinger MK, Leichtman AB, et al. Impact of the expanded criteria donor allocation system on candidates for and recipients of expanded criteria donor kidneys. Transplantation. 2007;84:1138–44.PubMedCrossRefGoogle Scholar
  26. 26.
    Cosio FG, Alamir A, Yim S, et al. Patient survival after renal transplantation: I. The impact of dialysis pre-transplant. Kidney Int. 1998;53:767–72.PubMedCrossRefGoogle Scholar
  27. 27.
    Meier-Kriesche HU, Port FK, Ojo AO, et al. The expanded criteria donor policy: an evaluation of program objectives and indirect ramifications. Am J Transplant. 2006;6:1689–95. Expanded Criteria Donor Policy time on renal transplant outcome. Kidney Int. 2000;58:1311–17.PubMedCrossRefGoogle Scholar
  28. 28.
    Meier-Kriesche HU, Port FK, Rudich SM, Leichtman AB, Kaufman DB, Kaplan B. Effect of waiting time and primary renal disease on mortality after renal transplantation. Transplantation. 2000;69:S261.CrossRefGoogle Scholar
  29. 29.
    Nyberg SL, Baskin-Bey ES, Kremers W, Prieto M, Henry ML, Stegall MD. Improving the prediction of donor kidney quality: Deceased donor score and resistive indices. Transplantation. 2005;80:925–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Sung RS, Christensen LL, Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion. Am J Transplant. 2008;8:783–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Muruve NA, Steinbecker KM, Luger AM. Are wedge biopsies of cadaveric kidneys obtained at procurement reliable? Transplantation. 2000;69:2384–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Andreoni KA, Brayman KL, Guidinger MK, Sommers CM, Sung RS. Kidney and pancreas transplantation in the United States, 1996–2005. Am J Transplant. 2007;7:1359.PubMedCrossRefGoogle Scholar
  33. 33.
    Schold JD, Meier-Kriesche HU. Which renal transplant candidates should accept marginal kidneys in exchange for a shorter waiting time on dialysis? Clin J Am Soc Nephrol. 2006;1:532–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK. Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation. 2007;83:1069–74.PubMedCrossRefGoogle Scholar
  35. 35.
    Andres A, Morales JM, Herrero JC, et al. Double versus single renal allografts from aged donors [see comment]. Transplantation. 2000;69:2060–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Meier-Kriesche HU, Sebold JD, Gaston RS, Wadstrom J, Kaplan B. Kidneys from deceased donors: maximizing the value of a scarce resource. Am J Transplant. 2005;5:1725–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Swanson SJ, Hypolite IO, Agodoa LY, et al. Effect of donor factors on early graft survival in adult cadaveric renal transplantation. Am J Transplant. 2002;2:68–75.PubMedCrossRefGoogle Scholar
  38. 38.
    Gill JS, Schaeffner E, Chadban S, et al. Quantification of the early risk of death an elderly kidney transplantation recipients. Am J Transplant. 2013;13:427–32.PubMedCrossRefGoogle Scholar
  39. 39.
    Filmore H. Cardiac assessment for renal transplantation. Am J Transplant. 2006;6:659–65.CrossRefGoogle Scholar
  40. 40.
    Kauffman HM, McBride MA, Cors CS, Roza AM, Wynn JJ. Early mortality rates in older kidney recipients with comorbid risk factors. Transplantation. 2007;83:404–10.PubMedCrossRefGoogle Scholar
  41. 41.
    Pokoma E, Vitko S, Chadimova M, et al. Proportion of glomerulosclerosis in procurement wedge renal biopsy cannot alone discriminate for acceptance of marginal donors. Transplantation. 2000;69:36–43.CrossRefGoogle Scholar
  42. 42.
    Pokoma E, Vftko S, Chadimova M, Schiick O. Adverse effect of donor arteriolosclerosis on graft outcome after renal transplantation. Nephrol Dial Transplant. 2000;15:705–10.CrossRefGoogle Scholar
  43. 43.
    Lu AD, Desai D, Myers BD, Dafoe DC, Alfrey EJ. Severe glomerular sclerosis is not associated with poor outcome after kidney transplantation. Am J Surg. 2000;180:470–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Cicciarelli J, Cho Y, Mateo R, et al. Renal biopsy donor group: the influence of glomerulosclerosis on transplant outcomes. Transplant Proc. 2005;37:712–3.PubMedCrossRefGoogle Scholar
  45. 45.
    Sung RS, Christensen LL, Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion. Am J Transplant. 2008;8:783–92.PubMedCrossRefGoogle Scholar
  46. 46.
    Setti G, Sandrini S, Cancarini G, et al. Reliability of clinical parameters for the selection of elderly cadaveric donors. Transplant Proc. 2001;33:1164–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Merion RM, Ashby VB, Wolfe RA, et al. Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA. 2005;294:2726–33.PubMedCrossRefGoogle Scholar
  48. 48.
    Wolfe RA, Roys EC, Merion RM. Trends in organ donation and transplantation in the United States. 1998-. Am J Transplant. 2010;10:961–72.PubMedCrossRefGoogle Scholar
  49. 49.
    Mezrich JD, Pirsch JD, Fernandez LA, et al. Differential outcomes of expanded criteria donor renal allografts according to recipient age. Clin J Am Sco Nephlorol. 2012;7:1163–71.CrossRefGoogle Scholar
  50. 50.
    Sung RS, Guidinger MK, Lake CD, et al. Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys. Transplantation. 2005;79:1257–61.PubMedCrossRefGoogle Scholar
  51. 51.
    Morris PJ, Johnson RJ, Fuggle SV, Belger MA, Briggs JD. Analysis of factors that affect outcome of primary cadaveric renal transplantation in the UK. Lancet. 1999;1:1147.CrossRefGoogle Scholar
  52. 52.
    The Organ Procurement and Transplantation Network. Allocation of Deceased Kidneys. Accessed 23 Nov 2005.
  53. 53.
    Sola R, Guirado L, Lopez-Navidad A, et al. Renal transplantation with limit donors: to what should the good results obtained be attributed? Transplantation. 1998;66:1169.Google Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  1. 1.Division for Innovative Surgery and TransplantationNational Center for Child Health and DevelopmentTokyoJapan

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