Spanish consensus document for acceptance and rejection of kidneys from expanded criteria donors.

In the recent years, more than 60% of available deceased donors are either older than 50 yr or have significant vascular comorbidities. This makes the acceptance and rejection criteria of renal allografts very rigorous, especially in cases of younger recipients, and at the same time encourages live donations. In our country, there is a lack of homogeneity in the percentages of use of expanded criteria donor (ECD) allografts between the different autonomous communities. Furthermore, the criteria vary greatly, and in some cases, great importance is given to the biopsy while in others very little. In this study, we present a unified and homogenous criteria agreed upon by consensus of a 10-member Panel representing major scientific societies related to renal transplantation in Spain. The criteria are to be used in accepting and/or rejecting kidneys from the so-called ECDs. The goal was to standardize the use of these organs, to optimize the results, and most importantly to provide for the maximum well being of our patients. Finally, we believe that after taking into account the Panel's thorough review of specific scientific literature, this document will be adaptable to other national renal transplant programmes.

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors. / Niveles de capnometría como indicador de evolución de injerto renal de donantes en asistolia no controlada.

OBJECTIVE: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DESIGN: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. SCOPE: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PATIENTS: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. INTERVENTIONS: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. VARIABLES: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. RESULTS: A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P=.016) between the capnometry values during resuscitation in the grafted kidneys (µ=22.8 mmHg) and in the kidneys discarded for transplantation (µ=17.35 mmHg). CONCLUSIONS: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors.

Uncontrolled non-heartbeating donors (types i-ii) with normothermic recirculation vs. heartbeating donors: evaluation of functional results and survival.

OBJECTIVE: Non-heartbeating donors (NHBD) are an alternative to heartbeating donors (HBD). Our objective was to compare functional results and kidney survival from NHBDs and HBDs. MATERIAL AND METHODS: A retrospective study comparing the results of 236 normothermically preserved kidneys from type i and ii type NHBDs with the results of 250 from HBDs that were transplanted in our center between 2005 and 2012. Homogeneity between groups was tested and we evaluated the presence of delayed graft function (DGF) associated with pretransplant variables of the donor and recipient. RESULTS: Both groups show homogeneity in pretransplant characteristics in terms of: age, HLA incompatibilities, and recipient hemodialysis time. Average follow-up time was 33 months (range 0-87) for NHBDs and 38 months (range 0-90) for HBDs. 5.5% of NHBDs showed primary non-function (PNF) vs. 4% of HBDs (P=.42) and 80.9% of DGF vs. 46.8% of HBDs (P<.001). At the end of the follow-up, there were no statistically significant differences in the survival of grafts (92.8% for NHBD vs. 93.6% for HBD, P=.71) and recipients (99.1% NHBD vs. 98.6% HBD, P=.28). CONCLUSIONS: Although the DGF percentage was greater for NHBDs, final creatinine as well as graft and recipient survival were similar for both groups. Therefore, in our experience, kidneys from NHBDs have similar results to those from HBDs and are an excellent source of organs for transplantation.

Dual kidney transplantation involving organs from expanded criteria donors: a review of our series and an update on current indications.

BACKGROUND: Our purpose was to review our kidney transplantation program based on the use of expanded criteria donors, and to determine current indications for dual kidney transplantation (DKT). In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. METHODS: In 1996, a program was initiated to transplant kidneys from donors of over 60 years performing single or dual transplantation. DKT were performed with donors >75 and donors between 60 and 74 years of age and glomerulosclerosis of >15%. The kidneys of donors between 60 and 74 years of age and with glomerulosclerosis of <15% were used for single kidney transplantation (SKT). In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. RESULTS: From 1996 to 2004, 222 SKTs and 88 DKTs were performed. Graft survival after 1 and 4 years was, respectively, 91% and 78% for SKT and 95% and 79% for DKT. In 2005, we started to perform SKT despite glomerulosclerosis being >15%, taking into account donor and recipient characteristics. From 2005 to 2011, 328 SKT and 32 DKT were performed. During this period most kidneys used for DKT were from female donors >75 years old, weighing <65 kg, with a creatinine of >1 mg/dL and glomerulosclerosis of >15%. The recipients for DKT were mostly male, <70 years old and whose weight was >75 kg. CONCLUSION: DKT from expanded criteria donors shows good outcomes. However, in many cases SKT may fulfill the need of the recipient. The archetype for DKT is an older female weighing <65 kg and the most common recipient is an overweight male who is <70 years old.