Some discarded kidneys from deceased donors who fulfill both expanded criteria donor (ECD) and donation after circulatory death (DCD) definitions may be acceptable for transplantation, according to a new study.

The odds of kidney discard are significantly higher for ECD/DCD in older donors and those who have diabetes mellitus, hepatitis C antibody positivity, and blood type AB. 

Using data from the Scientific Registry of Transplant Recipients, Sunita K. Singh, MD, and S. Joseph Kim, MD, both of the University of Toronto and Toronto General Hospital, calculated the kidney donor risk index (KDRI) for all ECD/DCD kidneys. The study included 896 ECD/DCD donors and 1,792 kidneys.

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Results showed that 44.5% of donors had both kidneys discarded and that 51% of all available kidneys were discarded, Drs. Singh and Kim reported online ahead of print in the Clinical Journal of the American Society of Nephrology. The KDRI scores were higher among donors of discarded versus transplanted kidneys (median 1.82 vs. 1.67). In adjusted analyses, each 1 year of age was associated with a 5% increased odds of discard. Diabetes mellitus was associated with nearly 2-fold increased odds of discard and hepatitis C antibody positive was associated with 67% increased odds. Compared with blood type O (reference), blood type AB was associated with 2.9-fold increased odds.

Additionally, the cumulative probabilities of total graft failure at 1, 3, and 5 years were 17.3%, 36.5%, and 55.4%, respectively, among kidneys from donors with only 1 kidney transplanted compared with 13.8%, 24.7%, and 40.5%, respectively, among kidneys from donors with both kidneys were transplanted.

Two kidneys from 381 donors and 1 kidney from 116 donors were transplanted, and both kidneys from 399 donors were discarded.