Choosing the best kidney for transplantation

Reported by Susan Aldridge, PhD, medical journalist

A study shows that some patients are better off accepting a sub-optimal donor kidney than remaining on the waiting list.
The number of people needing a new kidney has increased in recent years - currently the waiting list stands at more than 64,000 - but the supply of donors has not kept pace with demand. That has led doctors to use so-called expanded criteria donors (ECD) whose organs would at one time not have been regarded as suitable - either because the donors are older or because they have medical problems.

A team at the University of Michigan Health System has done research for the Scientific Registry of Transplant Recipients to show the outcome for recipients of organs from ECD. This will help address the tricky issue of whether it's best to opt for an ECD organ now or remain on dialysis until a 'better' organ becomes available.

The researchers looked at what happened for a group of 109,127 on dialysis and waiting for a new kidney between 1995 and 2002, following them up to July 2004. By this time, 7,790 had received an ECD kidney, 41,052 a non-ECD kidney, 15,203 a living donor transplant and 45,082 either died or were still waiting.

In general, recipients of an ECD kidney had a 17 per cent lower long-term risk of dying compared to those on dialysis or receiving a non-ECD transplant. Those over 40 and who would have waited more than 44 months had most to gain. If the wait was going to be shorter, then only diabetic patients did better with an ECD kidney.

Source
Journal of the American Medical Association 7th December 2005 Volume 294 Number 22