Prediction of three-year outcome of renal transplantation from optimal donors versus expanded criteria donors.

Abstract:

BACKGROUND/AIMS:The shortage in organ supply has required the use of expanded criteria donors (ECD) for kidney transplantation. Current pre-transplant evaluations of ECD organs are based on histological, clinical or mixed criteria. This monocentric study investigates the predictivity of Karpinski's histological score on 3-year graft function in renal transplant. Ex-post classification using Nyberg's score was carried out to assess the reliability of a purely clinical score and its applicability for organ allocation. METHODS:We evaluated 407 deceased donors (251 optimal and 156 ECD) for renal transplants performed between 2001 and 2006. The differences in creatinine levels and MDRD-GFR at transplant and 1, 2 and 3 years post-transplant between optimal donors and ECD were recorded. Amongst ECD organs, the effect of different Karpinski score classes (0-1, 2, 3, 4, double transplants) on 3-year graft outcomes was analyzed. We then compared renal function over time across the Nyberg grades (A, B, C, and D). RESULTS:Karpinski scores 0-1 and 2 and double transplants were associated with improved graft function compared to scores 3 and 4. Nyberg's clinical score shows a good fit with medium-term outcome and Karpinski's score, but among the donors with a high Nyberg grade (C and D), it fails to differentiate between allocable or non-allocable organs (due to Karpinski's score ≥7). CONCLUSIONS:Our data demonstrate a correlation of histological damage at the time of transplant with 3-year graft function, but at present we are unable to provide any supposition on the possible outcome of the discarded kidneys.

journal_name

Am J Nephrol

authors

La Manna G,Comai G,Cappuccilli ML,Liviano D'Arcangelo G,Fabbrizio B,Valentini C,Carretta E,Ravaioli M,Scolari MP,Ridolfi L,Feliciangeli G,Grigioni FW,Pinna AD,Stefoni S

doi

10.1159/000346257

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

158-66

issue

2

eissn

0250-8095

issn

1421-9670

pii

000346257

journal_volume

37

pub_type

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