Renal transplantation with expanded criteria donors: Which is the optimal immunosuppression?

Core Tip

Core tip: Kidney donor shortage is chronic, persistent and increasing in most countries worldwide. Therefore, there has been renewed interest in the use of expanded criteria donors (ECD) to increase donor pool. Compared to standard criteria donor kidneys, ECD kidneys are associated with up to a two-fold increased risk of delayed graft function, acute rejection, and graft loss. The optimal induction and maintenance immunosuppressive regimen for ECD transplant recipients is not known due to shortage of randomized trials. Induction with antithymocyte globulin and maintenance with calcineurin inhibitors-sparing regimens have been advocated, especially for older recipients of ECD kidneys. This review provides insights into topics such as selection of appropriate candidates for kidney transplantation from ECDs, optimal management of ECD transplant recipients and discusses literature data on the immunosuppressive regimens that have been used in this patient population.