Expanded Criteria Donor Kidneys Where the Paired Kidney Is Discarded Owing To Biopsy Results: A Concept That Needs Revision

Objectives: We explored the categorizing of expanded criteria donors based on systemic disease processes linked to symmetric bilateral renal injury. Materials and Methods: We evaluated expanded criteria donor kidneys where the paired kidney was discarded owing to biopsy results, termed the discard group compared with those expanded criteria donors ( where both were transplanted), termed the nondiscard group. Analysis of the Organ Procurement and Transplant Network data was completed focusing on the effect of glomerulosclerosis. Results: Our investigation revealed 754 and 9575 recipients in the discard group and nondiscard groups. Fewer glomerulosclerosis was seen the nondiscard group. An assessment revealed improved 1-, 3-, and 5- year graft ( P < .001) and patient ( P < .05) survivals in the nondiscard group compared with the discard group. However, multivariate analysis demonstrated glomerulosclerosis had little to no effect on graft and patient survival. Expanded criteria donor kidneys with 0% to 5% glomerulosclerosis had no significant differences in graft function as compared with expanded criteria donor kidneys that had > 10% glomerulosclerosis. In fact, expanded criteria donor kidneys with 0% to 5% glomerulosclerosis showed no statistically significantly protective effect over any biopsy with > 5% glomerulosclerosis in patient survival. Conclusions: Owing to the limited supply of biopsy results in predicting outcomes when controlled for pertinent variables, relying on biopsy findings for kidney allocation may result in many valuable kidneys being discarded.