Thursday, October 7, 2010

Board question: Transplant answer

The correct answer is D.
The criteria for expanded-criteria donors (ECD) are:
  • age greater than 60 years old
  • age 50 to 59 years old and at least two of the following:
  1. History of hypertension
  2. Terminal creatinine > 1.5mg/dL
  3. Death from a cerebral vascular accident
This new category of renal transplantation donors was introduced in 2002 to help expand the pool of potential kidney donors. ECD are associated with a 70% higher risk of graft failure compared to non-ECD transplants. About 20% of deceased-donor transplants in 2008 are ECD kidneys in the US. The 3-year graft survival for ECD transplants was 67% in 2003. By comparison, the 3-year graft survival for non-ECD and living-donor transplants is 80 and 88%, respectively. Since the supply of suitable kidney transplants fails to match the increasing demands, nephrologists will need to determine if ECD transplants are appropriate for their patients. The decision must be individualized and patient-centered, since we have not identified the cohort for whom ECD transplants will most benefit. Expect to see a question regarding ECD transplants on the renal boards!

Michael Lattanzio DO

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