Long-Term Outcomes Similar for ECDs, SCDs

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QUEBEC CITY, QUEBEC—Kidneys from standard-criteria donors (SCDs) and expanded-criteria donors (ECDs) are associated with similar rates of long-term patient survival and death-censored graft survival, a study has confirmed.

The only significant difference in death-censored graft survival rates (for patients surviving longer than one year) was between ECD and SCD kidneys with slow graft function (SGF). The rates were approximately 75% and 92%, respectively, 10 years post-transplant.

In addition, the researchers determined that an estimated glomerular filtration rate (eGFR) decrease of more than 30% between one month and one year post-transplant is a strong predictor of death-censored graft survival and chronic kidney disease stage 4.

The researchers presented the results at the Canadian Society of Transplantation's 2012 Annual Meeting.

The use of kidneys from ECDs has increased significantly across North America over the last decade, but these kidneys are associated with a significantly increased risk of graft loss. To determine the impact of immediate outcomes on long-term outcomes, a team from the McGill University Health Centre in Montreal led by Nassima Smail, MD, studied the outcomes of the 471 consecutive recipients of deceased-donor kidneys at their center from January 1, 1990 to December 31, 2006.

Just over half of the patients (253, or 53.7%) received kidneys from SCDs. These recipients included 82 women with an average age of 49 years. The remaining 218 patients (46.3%) received kidneys from ECDs. These recipients had an average age of 52 years. The group included 73 women.

In July 1997, the transplant team at the McGill University Health Centre changed the immunosuppressive regimen for kidney recipients from cyclosporine to tacrolimus and from azathioprine to mycophenolate mofetil.

The investigators found no significant differences in 10-year patient survival rates between patients who received kidneys from ECDs and SCDs, regardless of whether the kidneys had immediate, slow, or delayed graft function post-transplant. The researchers also observed similar 10-year death-censored graft survival rates in patients with either immediate graft function (IGF) or delayed graft function (DGF), with the only exception being between ECD and SCD kidneys with SGF.

The analyses also revealed significant predictors of death. Each one-year increment in recipient age was associated with a 5.8% increased risk of death, and each one-unit increment in serum creatinine was associated with a 0.8% increased risk. Patients receiving a second transplant had a twofold increased risk of death. Tacrolimus use during the first month post-transplant was associated with a 39.5% decreased risk.

Dr. Smail's team also identified significant predictors of death-censored graft loss. Each one-unit increment in serum creatinine at one year was associated with a 2.7% increased risk of death-censored graft loss. An eGFR decline greater than 30% between one and 12 months post-transplant was associated with a twofold increased risk.

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