The Expanded Criteria Donors in Kidney Transplantation: 3 Years Experience FAM Shaheen, B. Al-Attar, MZ Souqiyyeh, J.E Cillo, A. Al Sayyari Saudi Center For Organ Transplantation, Riyadh, Kingdom of Saudi Arabia

 Kidney Transplantation is the preferred therapy for most patients with ESRD and is superior to dialysis in terms of long term mortality risk.  The poll of renal transplant candidates has increased dramatically.  There is a significant need for kidneys from deceased donors. Introduction Objectives  Identify and analyze the use of Expanded Criteria Donor Kidneys.  The outcome of kidney transplantation in Saudi Arabia.

Methods  A retrospective study of all deceased donor transplantation carried out from the year 2008 – Investigating the impact on graft and patient survival and graft function of Expanded Criteria Donor Kidneys compared to Standard Criteria Donors (SCD).

Results No. of Consented DD No. of Retrieved DD For Kidneys No. of Retrieved Kidneys No. of Transplanted Kidneys *432 (94%) * Donor Characteristic: Age ≥ 60y.o Age 50 – 59y.o / CVA / HTN and or S. Cr ≥ 133 µmol/L ( 1.5 mg/dl ) CVA / HTN / S. Cr doubled at harvesting ECDSCD 68(16%)364 (84%) TOTAL Kidneys Note: 2 transplanted Kidneys from HCV positive donor 7 Kidneys 43 Kidneys 18 Kidneys SCD = Standard Criteria Donors ECD = Expanded Criteria Donors

Results Donor Characteristics Total Donors P-ValueDonor Characteristics ECDSCDAll DonorsFactors < years39 years 37 ± 11.4 (3m – 71) years Mean Age NS89%90% Males < %38 %49 %Traumatic NS 8 (2-16) days 8 (2-35) days 8 (2-35) days Mean Period from Admission to Harvesting NS143 µmol/L106 µmol/L112 µmol/L Mean Scr. on Admission µmol/L129 µmol/L145 µmol/LMean Scr. at Harvesting

Results Recipient Characteristics P-ValueRecipient Characteristics ECDSCDAll RecipientsFactor (13-75) yrs33 (2-77) yrs35 (2 -77) yrsMean Age NS 15 (3-30) hrs 14 ( ) hrs 14.2 ( ) hrs CIT NS32 (6-127) days 19 (4-535) days 21.9 (4-535) days Mean Period from Tx. To Discharge µmol/L153 µmol/L183 µmol/L Mean Scr. at Discharge %14 %19.7 % Delayed Graft Function %3 %8 % Episode of Acute Rejection -2NIL2Death before Discharge

Results Patient Follow-up Kidney Type, No. / % Status 430 Total Kidney Recipients / 100% 365 SCD Kidney Recipients / 100% 68 ECD Kidney Recipients / 100% Graft is Active380 / 80%329 / 90%57 / 84% Graft is Loss6 / 1%4 / 1%2 / 3% Patient Loss Follow up 10 / 2%7 / 2%3 / 4% Patient Died12 / 3%7 / 3%4 / 6% Total:408 / 95%347 / 96%66 / 97%

Conclusions  The use of marginal kidney donors is an acceptable method to use in specified category of patients on waiting list for kidney transplantation in Saudi Arabia.  The outcome of marginal kidney transplantation is comparable to international data.