Two articles in this issue relay new findings on one of the most pressing and controversial issues in nephrology: increasing the number of donor kidneys available for transplantation. The solution examined in each article is the use of more kidneys from expanded criteria donors (ECD).
The article beginning on page 1 describes an important paper presented during the American Society of Nephrology’s recent Renal Week 2007 in San Francisco. It showed that, in elderly recipients, ECD kidneys from brain-dead donors provide better outcomes than ECD kidneys donated following cardiac death.
The second article (page 10) reports on three studies presented at the 13th Congress of the European Society for Organ Transplantation in Prague. In one study, researchers at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. demonstrated that the use
of conventional ECD kidneys and “extreme” ECD kidneys are associated with similar patient and graft survival. These similar outcomes, senior researcher Robert Stratta, MD, observed, suggest that the limits of acceptability for ECDs continue to expand.
ECD kidneys include organs from deceased donors over age 60 or those over age 50 with health conditions such as hypertension, stroke, or elevated creatinine levels. For the WakeForest study, extreme donors were ECDs with any of the following additional criteria: deceased donor age above 70, donation after cardiac death, greater than 30% glomerulosclerosis on biopsy, cold ischemia time greater than 30 hours, or calculated deceased donor creatinine clearance of less than 60 mL/min.
Although these organs would not be the first choice for transplantation, they could come into much wider use if dire predictions about the end-stage renal disease (ESRD) population come true. In a study presented during Renal Week 2007, researchers projected that the number of ESRD patients in the United States in 2020 will be almost 800,000, an increase of more than 60% from the 2005 ESRD population.
Moreover, a new study in the Journal of the American Medical Association by Joseph Coresh and his colleagues shows that the prevalence of CKD stages 1-4 in the U.S. population increased from 10% in 1988-1994 to 13% in 1999-2004. The authors state that the increasing prevalence of diagnosed diabetes and hypertension has contributed to this increase, which may propagate to higher rates of complications and kidney failure requiring dialysis or transplantation. In light of these trends, the use of more ECD kidneys seems inevitable.