Expanded Criteria Living kidney donation
Traditional kidney donation involves only donors who are less than 60 years old and free of medical conditions [1]. Due to the increased knowledge of donor outcomes, better treatment of comorbidities, aging population, and increased need for kidney donors, many hospitals are easing up on their selection criteria for donors [1].
Characteristics of living donors that would deem them as "expanded criteria" include any of the following [1]:
A considerable amount of evidence supports the safety and efficacy of older living kidney donors as slightly inferior to standard criteria kidney donors and superior to standard criteria deceased donors in the short and intermediate term [1,2]. Accepting other expanded criteria living kidney donors has not in practice long enough to be certain of how this impacts recipients and donors in the long term [1,3]. Of note, some studies have shown that kidneys from obese donors may perform worse when transplanted in to a petite recipient- possibly due to inadequate vascularization to the donor kidney [3].
1. Iordanous Y, Seymour N, Young A, Johnson J, Iansavichus AV, Cuerden MS, Gill JS, Poggio E, Garg AX; Donor Nephrectomy Outcomes Research (DONOR) Network. Recipient outcomes for expanded criteria living kidney donors: the disconnect between current evidence and practice. 2009. Am J Transplant. 9(7):1558-73.
2. Young A, Storsley L, Garg AX, Treleaven D, Nguan CY, Cuerden MS, Karpinski M. Health outcomes for living kidney donors with isolated medical abnormalities: a systematic review. 2008. Am J Transplant. 8(9):1978-90.
3. Lin J, McGovern ME, Brunelli SM, Gaccione P, Malek S, Tullius SC, Chandraker AK, Milford EL. Longitudinal trends and influence of BMI mismatch in living kidney donors and their recipients. 2011. Int Urol Nephrol. 43(3):891-7.
Characteristics of living donors that would deem them as "expanded criteria" include any of the following [1]:
- >60 years of age
- Hypertension
- Obesity
- Low eGFR
- Microalbuminuria
- Kidney stones
- Many more!
A considerable amount of evidence supports the safety and efficacy of older living kidney donors as slightly inferior to standard criteria kidney donors and superior to standard criteria deceased donors in the short and intermediate term [1,2]. Accepting other expanded criteria living kidney donors has not in practice long enough to be certain of how this impacts recipients and donors in the long term [1,3]. Of note, some studies have shown that kidneys from obese donors may perform worse when transplanted in to a petite recipient- possibly due to inadequate vascularization to the donor kidney [3].
1. Iordanous Y, Seymour N, Young A, Johnson J, Iansavichus AV, Cuerden MS, Gill JS, Poggio E, Garg AX; Donor Nephrectomy Outcomes Research (DONOR) Network. Recipient outcomes for expanded criteria living kidney donors: the disconnect between current evidence and practice. 2009. Am J Transplant. 9(7):1558-73.
2. Young A, Storsley L, Garg AX, Treleaven D, Nguan CY, Cuerden MS, Karpinski M. Health outcomes for living kidney donors with isolated medical abnormalities: a systematic review. 2008. Am J Transplant. 8(9):1978-90.
3. Lin J, McGovern ME, Brunelli SM, Gaccione P, Malek S, Tullius SC, Chandraker AK, Milford EL. Longitudinal trends and influence of BMI mismatch in living kidney donors and their recipients. 2011. Int Urol Nephrol. 43(3):891-7.
Articles of interest
- Iordanous Y, Seymour N, Young A, Johnson J, Iansavichus AV, Cuerden MS, Gill JS, Poggio E, Garg AX; Donor Nephrectomy Outcomes Research (DONOR) Network. Recipient outcomes for expanded criteria living kidney donors: the disconnect between current evidence and practice. 2009. Am J Transplant. 9(7):1558-73.
- Lim WH, Clayton P, Wong G, Campbell SB, Cohney S, Russ GR, Chadban SJ, McDonald SP. Outcomes of Kidney Transplantation from Older Living Donors. 2013. Transplantation. 95(1):106-13.
- Serur D, Charlton M. Expanded criteria living donors: how far can we go? 2012. Prog Transplant. 22(2):129-32. <Free full text>
- Schnitzler MA, Gheorghian A, Axelrod D, L’italien G, Lentine KL. The cost implications of first anniversary renal function after living, standard criteria deceased and expanded criteria deceased donor kidney transplantation. 2013. J Med Econ. 16(1):75-84.
- Young A, Kim SJ, Speechley MR, Huang A, Knoll GA, Prasad GV, Treleaven D, Diamant M, Garg AX; Donor Nephrectomy Outcomes Research (DONOR) Network. Accepting kidneys from older living donors: impact on transplant recipient outcomes. 2011. Am J Transplant. 11(4):743-50.
- Young A, Storsley L, Garg AX, Treleaven D, Nguan CY, Cuerden MS, Karpinski M. Health outcomes for living kidney donors with isolated medical abnormalities: a systematic review. 2008. Am J Transplant. 8(9):1978-90.