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Combined predictive value of the expanded donor criteria for long‐term graft survival of kidneys from donors after cardiac death: A single‐center experience over three decades
Author(s) -
Kusaka Mamoru,
Kubota Yusuke,
Sasaki Hitomi,
Fukami Naohiko,
Fujita Tamio,
Hirose Yuichi,
Takahashi Hiroshi,
Kenmochi Takashi,
Shiroki Ryoichi,
Hoshinaga Kiyotaka
Publication year - 2016
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.13045
Subject(s) - medicine , single center , creatinine , renal function , univariate analysis , risk factor , multivariate analysis , urology , surgery
Objectives Kidneys procured from the deceased hold great potential for expanding the donor pool. The aims of the present study were to investigate the post‐transplant outcomes of renal allografts recovered from donors after cardiac death, to identify risk factors affecting the renal prognosis and to compare the long‐term survival from donors after cardiac death according to the number of risk factors shown by expanded criteria donors. Methods A total of 443 grafts recovered using an in situ regional cooling technique from 1983 to 2011 were assessed. To assess the combined predictive value of the significant expanded criteria donor risk criteria, the patients were divided into three groups: those with no expanded criteria donor risk factors (no risk), one expanded criteria donor risk factor (single‐risk) and two or more expanded criteria donor risk factors (multiple‐risk). Results Among the donor factors, age ≥50 years, hypertension, maximum serum creatinine level ≥1.5 mg/dL and a warm ischemia time ≥30 min were identified as independent predictors of long‐term graft failure on multivariate analysis. Regarding the expanded criteria donors criteria for marginal donors, cerebrovascular disease, hypertension and maximum serum creatinine level ≥1.5 mg/dL were identified as significant predictors on univariate analysis. The single‐ and multiple‐risk groups showed 2.01‐ and 2.40‐fold higher risks of graft loss, respectively. Conclusions Renal grafts recovered from donors after cardiac death donors have a good renal function with an excellent long‐term graft survival. However, an increased number of expanded criteria donors risk factors increase the risk of graft loss.