By carefully matching the estimated function of kidneys from deceased donors with the needs of potential recipients, surgeons can successfully transplant kidneys that would otherwise be discarded, according to a report from
Wake Forest University Baptist Medical Center. The center was able to double its transplant volume within a year.
In addition, a second report concludes that age alone shouldn’t prohibit older adults from being organ donors – or having a kidney transplant themselves – success rates are similar in older and younger patients.
“There is a critical shortage of kidneys for transplantation, which puts us in the difficult situation of rationing organs,” said Robert Stratta, M.D., director of Transplantation Services at Wake Forest Baptist. “Newer ways to match organs to recipients allow us to use kidneys that once were considered unsuitable.”
In the May issue of Annals of Surgery, Stratta and colleagues reported on their experience using kidneys under a new system that was implemented by the United Network for Organ Sharing (UNOS) in 2001. It allows the use of kidneys from deceased donors over age 60, as well as from donors over age 50 with at least two of the following: high blood pressure, fatal stroke, or certain levels of a protein called creatinine. Levels of creatine, which is produced by muscle, are used to determine kidney function.
Using kidneys from these donors, which UNOS calls expanded criteria donors (ECDs), permits more patients to benefit from transplantation, Stratta said, without affecting either patient survival or short-term survival of the transplanted kidney.
Transplant centers across the nation are working to determine how to use the organs most effectively. Wake Forest Baptist’s approach is to estimate the function of a donated kidney and to match it with the needs of a potential recipient.
“In the past, kidneys were matched exclusively by blood and tissue type,” said Stratta. “Now, we are matching based on age, weight and kidney function. Someone who weighs less doesn’t need as much transplanted kidney capacity; it is a concept that is in evolution.”
Stratta and colleagues compared survival rates and other measures of success in 53 patients who received kidneys from standard criteria donors (SCDs) and 37 patients who received kidneys from ECDs. Patients were followed for an average of 16 months. Patient and kidney graft survival rates were similar between the two groups.
“The use of ECD kidneys at our center doubled our transplant volume within one year,” said Stratta. “A systematic approach to matching ECD kidneys that is based on kidney function seems to provide short-term outcomes that are comparable to SCD kidneys.”