Quebec experience from 2003 to 2009 M Carrier MD, JF Lize MD and Quebec transplant programs Impact of Expanded Criteria Donors on outcomes of recipients of kidney transplantation

Introduction Expanded criteria donors (ECD) represent a large proportion of our total population of organ donors. The use of marginal or ECD has become a common clinical practice because of the gap between the number of candidate for renal transplantation and the number of donor available.

Objective The objective of the present study is to compare outcomes of patients who underwent kidney transplantation with ECD versus standard criteria donors (SCD) in our patient population Ensemble pour le don d'organesTransplant Québec3

Source: 2009 OPTN/SRTR Annual Report, Tables 5.14a, b, d. Figure III-6. Unajusted 1-Year ( ), 5-Year ( ) and 10-Year ( ) Kidney Recipient Survival, by Donor Type

Methods Retrospective review of donors used for organ transplantation from 2003 to Analyses of patient survival and of graft survival with a clinical follow up until may Patient and graft survival were studied with uni and multivariate methods in regard to the effect of donor and recipients characteristics.

Methods We studied 792 deceased donors and 1375 adult recipients of kidney transplants in six Quebec centers between 2003 and Mean follow-up period was 3.5 ± 2 years Ensemble pour le don d'organesTransplant Québec6

Donors characteristics DONORS Standard criteria 510 donors (64%) Extended criteria 282 donors (36%) P AGE (years)39 ± 1465 ± Gender298 (58%) M 212 (42%) W 135 (48%) M 147 (52%) W Weight (kg)72 ± 1976 ± Causes of death CVA vs others 229 (45%) vs 281 (55%) 242 (86%) vs 40 (14%) Serum creatinine (mmol/l) 77 ± 4575 ± Ensemble pour le don d'organesTransplant Québec7

Recipients characteristics RECIPIENTS Standard criteria 919 recipients Extended criteria 456 recipients P AGE (years)49 ± 1356 ± Waiting time to transplantation (days) 771 ± ± HLA DR mismatch0: 357 1: 311 2: 251 0: 155 1: 146 2: Ensemble pour le don d'organesTransplant Québec8

Patient survival after kidney transplantation Extended versus standard donor criteria P = 0.47

Patient survival after transplantation Multivariate analyses (Cox) of risk factors DONORSRELATIVE RISK Confidence limits 95% P Age (years) Creatinine (mmol/L) Female gender * Extended criteria donors RECIPIENTS Age at transplantation * Waiting time (days) * No of HLA DR mismatches

Graft survival Extended versus standard donor criteria P = 0.28

Graft survival Multivariate analyses (Cox) of risk factors DONORSRELATIVE RISK Confidence limits 95% P Age (years) * Creatinine (mmol/l) Female gender Extended criteria donors RECIPIENTS Age at transplantation * Waiting time (days) * No of HLA DR mismatches

Interpretation of results Patient and graft survival were excellent at short term follow-up after kidney transplantation with both standard and extended donor criteria. Risk factors for patient death after kidney transplantation were donor female gender, recipient age and waiting time to transplantation. Risk factors for graft loss were donor and recipient age and waiting time to transplantation.

Conclusion The present study showed that the actual definition of ECD had no effect on patient and graft survival 5 years after transplantation in our patient population Ensemble pour le don d'organesTransplant Québec14

Thanks to all co-autors and collaborators: University of Montréal: Dr A. Boucher, Dr R. Dandavino, Dr M. Paquet McGill Univeristy: Dr M. Cantarovich University of Sherbrooke: Dr Wolff Laval University: DR I. Houde

Graft survival Donors < 65 years versus ≥ 65 years