Outcomes of living donor kidney transplantation from extended criteria donors to extended criteria recipients: A retrospective cohort study

doi:10.5500/wjt.v15.i4.111031

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Transplant. Dec 18, 2025; 15(4): 111031
Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.111031

Outcomes of living donor kidney transplantation from extended criteria donors to extended criteria recipients: A retrospective cohort study

Nikolaos Andreas Anastasopoulos, Rawya Charif, Marina Loucaidou, Paul E Herbert, Anand S R E Muthusamy, Frank J M F Dor, Vassilios E Papalois

Nikolaos Andreas Anastasopoulos, Rawya Charif, Marina Loucaidou, Paul E Herbert, Anand S R E Muthusamy, Frank J M F Dor, Vassilios E Papalois, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom

Paul E Herbert, Anand S R E Muthusamy, Vassilios E Papalois, Department of Surgery and Cancer, Imperial College London, London SW7 5NH, United Kingdom

Author contributions: Anastasopoulos NA performed the research, analysed the data, and wrote the first draft of the manuscript; Anastasopoulos NA and Papalois VE designed the research study; all authors have read, contributed significant corrections and approved the final manuscript.

Institutional review board statement: As this is retrospective cohort study and patients consent to their anonymised data being used for research purposes and publications when they consent for their operations, along with the fact that this was undertaken as an audit project, no need for further institutional review was established.

Informed consent statement: All patients when signing the consent form are explained that their anonymised data could be used for research purposes and in future publications.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: No additional data are available.

Corresponding author: Vassilios E Papalois, Consultant, Professor, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, 72 DuCane Road, London W12 0HS, United Kingdom. vassilios.papalois@nhs.net

Received: June 23, 2025
Revised: July 14, 2025
Accepted: October 30, 2025
Published online: December 18, 2025
Processing time: 150 Days and 21.2 Hours

Abstract

BACKGROUND

Living donor kidney transplantation (LDKT) is considered the gold standard for treating end-stage kidney disease. Previous studies have highlighted the impact of donor and recipient demographics in influencing post-transplant outcomes. We believe that patient and graft outcomes in a tertiary university hospital setting will have no difference between pairs of standard criteria vs pairs of extended criteria (EC) donors and recipients in LDKT.

AIM

To investigate the outcomes of allocating EC donation (ECD) kidneys to EC recipients (ECR) in LDKT and compare them to standard and mixed standard and EC pair counterparts.

METHODS

We collected data from adult LDKTs conducted between April 2017 and April 2022. Donor-recipient pairs were grouped based on criteria as follows: (1) Group 1: Standard criteria donor (SCD) to standard criteria recipient (SCR); (2) Group 2: SCD to ECR; (3) Group 3: ECD to SCR; and (4) Group 4: ECD to ECR.

RESULTS

A total of 149 living donor transplants were analysed over a 5-year period. Graft survival, patient survival, and graft function were similar across all four groups. The incidence of common postoperative complications was as follows: (1) Perioperative bleeding (5.6%); (2) Surgical site infection (6.8%); and (3) Incisional hernia (7.4%). No statistically significant differences were found in patient or graft outcomes amongst the four groups. Multivariate analysis showed that group 4 recipients might experience inferior 5-year graft function (β = -11.8, P = 0.037) when compared with group 1.

CONCLUSION

In LDKT, long-term patient and graft outcomes are comparable amongst different combinations of standard vs EC donors and recipients. These findings show the primary potential of living donor ECD to ECR kidney transplantation with satisfying outcomes.

Keywords: Extended criteria; Living donor; Kidney transplantation; Cardiometabolic risk; Rejection

Core Tip: This retrospective cohort study aims to showcase the equivalent patient and graft outcomes following living donor kidney transplantation when pairs of standard criteria donors and recipients are compared to their extended criteria counterparts. This could serve as an important extension to the living donor pool in kidney transplantation, allowing easier access to the golden standard in treating end-stage kidney disease.