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

Table 1 Overall recipient and donor characteristics, n (%)

	Mean	SD	Median	Interquartile range	Frequency
Recipient age	47.3	13.7	48	19
Recipient HTN					4 (2.7)
Recipient atheroma					12 (8.1)
Recipient DM					21 (14.1)
Recipient BMI (kg/m2)	27.1	2.95	27	4
Donor age	47.7	12.3	48	19
Donor HTN					1 (0.7)
Donor atheroma					2 (1.3)
Donor DM					9 (6)
Donor BMI (kg/m2)	27.7	4.57	27	4.57
Donor baseline estimated glomerular filtration rate			90	0

BMI: Body mass index; DM: Diabetes mellitus; HTN: Hypertension.

Table 2 Perioperative characteristics of living donor kidney transplantation. mean cold ischaemic time (from time of kidney perfused with hypothermic perfusion solution to time out of ice), n (%)

Maintenance immunosuppression
Tacrolimus	78 (53)
Tacrolimus + mycophenolate	32 (21.4)
Tacrolimus + prednisolone + mycophenolate	25 (16.8)
Tacrolimus + prednisolone	12 (8.1)
Mismatch category (National Health Service Blood and Transplant)
1	17 (11.4)
2	18 (12.1)
3	67 (45)
4	47 (31.5)
Cold ischaemia time (minutes) (mean ± SD)	251 ± 104
Vascular anatomy
Single	118 (79.2)
Multiple	24 (16.1)
Reconstruction	7 (4.7)
Modality of donor nephrectomy
Mini open	24 (16.1)
Hand-assisted retroperitoneoscopic	42 (28.1)
Laparoscopic (including, hand-assisted)	83 (55.7)

Table 3 Overall recipient outcomes, n (%)

Classification	Frequency
Length of stay	7 (2)
Delayed graft function	1 (0.67)
Perioperative bleeding	7 (5.6)
Surgical site infection	6 (4)
Overall incisional hernia	11 (7.4)
Death with a functioning graft	3 (2)
Return to dialysis	9 (6)
Time to return to dialysis	43.1 ± 12.1
1-year recipient survival	99.3
3-year recipient survival	96.4
5-year recipient survival	94.6
1-year graft survival	99.3
3-year graft survival	97.2
5-year graft survival	90.4
1-year recipient eGFR	59.2 ± 16.3
3-year recipient eGFR	54.6 ± 19.9
5-year recipient eGFR	52.1 ± 22.5
5-year rejection	19 (17)
1-year donor eGFR	67 (21.5)
3-year donor eGFR	68 (21)
5-year donor eGFR	70 (21)

Length of stay in days is expressed as median and interquartile range. Time to return to dialysis is expressed in months. One-year, three-year and five-year recipient estimated glomerular filtration rate (eGFR) post-transplant are expressed as mean ± SD. Donor eGFR post donation does not follow a normal distribution and is expressed as median and interquartile range. eGFR: Estimated glomerular filtration rate.

Table 4 Donor and recipient outcomes for subgroup analysis post living donor kidney transplantation, n (%)

	Group 1	Group 2	Group 3	Group 4	P value
Delayed graft function	0	1	0	0	0.398
Perioperative bleeding	2	2	1	2	0.615
Surgical site infection	3	1	1	1	0.941
Incisional hernia	0	2	3	2	0.227
1-year recipient survival	100	100	97.5	100	0.433
1-year graft survival	100	100	97.5	100	0.433
1-year recipient eGFR	63.9 ± 15.3	55.9 ± 16.5	56.1 ± 14.6	58 ± 19.5	0.053
1-year donor eGFR	67 (15.2)	69 (14)	67.6 (15.7)	69.8 (14.2)	0.834
3-year recipient survival	98.1	97	97.4	89.5	0.451
3-year graft survival	98.1	97	90	90.9	0.383
3-year recipient eGFR	60 ± 19.3	52.3 ± 20.2	52 ± 16.7	51 ± 22.6	0.136
3-year donor eGFR	71.2 (15)	71.8 (15)	70 (14.7)	67.6 (15.1)	0.801
5-year recipient survival	97	92.8	85.3	82.4	0.170
5-year graft survival	97	96	86.7	82.3	0.143
5-year recipient eGFR	57.8 ± 21.6	51.7 ± 21.5	50.4 ± 22.3	45 ± 25.5	0.270
5-year rejection	9 (26.5)	3 (10.7)	6 (18.2)	1 (5.9)	0.247
5-year donor eGFR	70 (17.2)	71.7 (14.3)	72 (16)	72 (12)	0.568

Graft function follows normal distribution in all subgroups and is expressed as mean ± SD, whereas as for the donors it is expressed as median and interquartile range. eGFR: Estimated glomerular filtration rate.

Table 5 Linear regression analysis model for 5-year graft function

Predictor	β	SE	P value
5-year patient survival	24.61	17.96	0.174
Return to dialysis	-41.37	6.44	0.001
Rejection	-14.31	4.94	0.005
Subgroup comparisons
1 and 2	-6.30	4.77	0.189
1-3	-4.25	4.57	0.354
1-4	-11.80	5.58	0.037
Intercept	38.25	18.23	0.038

The adjusted R² is 0.384.