Impact of Recipient and Donor Nonimmunologic Factors on the Outcome of Deceased Donor Kidney Transplantation M.F. Shaheen, F.A.M. Shaheen, B. Attar, K. Elamin, H. Al Hayyan, and A. Al Sayyari ABSTRACT Objective. To study the influence of nonimmunologic factors on the outcome of extended criteria deceased donor (DD) kidney transplants. Method. This is a retrospective study of DD transplantation carried out from January 1, 2003 to December 31, 2007, to investigate the impact on graft survival and function of donor renal function at retrieval, cold ischemia time (CIT), delayed graft function (DGF), acute rejection episodes (ARE), age, and weight of donors and recipients, transplant center activities, cause of donor death, donor-recipient gender pairing and size of the donating intensive care unit (ICU). Results. At retrieval, the frequency of donors with a creatinine clearance 60 mL/min, using the Cockcroft–Gault formula, and age 40 years were 31.7% and 32%, respectively. CIT  24 hours, DGF, and ARE occurred in 27.1%, 33.4%, and 16.5% of cases, respectively. The overall 1- and 5-year graft and patient survival rates were 88% and 79.8% and 96.6% and 92.3%, respectively. The graft function was inferior with occurrences of ARE (P = .0001), DGF (P = .0001), CIT  20 hours (P = .005), nontraumatic the donor death (P = .022), and donor ICUs bed capacity 20 (P = .03). The odds ratio (OR) for graft loss with DGF, ARE, and donors right kidneys were 7.74 (95% confidence interval [CI] 6 –13.4; P = .0001), 4.47 (95% CI, 2.6 –7.6; P = .0001) and 1.7 (95% CI, 1–2.8; P = .045), respectively. Graft function was not influenced by donor renal function at retrieval, donor weight, or donor– recipient gender pairings. Conclusion. CIT and ARE had an impact on both graft survival and function. DGF and cerebrovascular accidents as the cause of donor death negatively affected graft function during follow-up. ICU center experience had a positive impact on graft survival. Patient survival was affected by recipient age 50 years and female to male donation versus other gender pairings. Neither donor age nor acute terminal rise in the donor serum creatinine affected graft function or survival, or patient mortality. E XTENDED CRITERIA donors (ECD) are being in- creasingly used due to the shortage of available kid- neys. 1 However reports on outcomes show conflicting re- sults. 2,3 ECD kidneys are defined as those with a relative risk of graft loss 1.70 over standard kidney transplants. They include kidneys from donors aged 60 years; or 50 –59 years with 2 of the following: an history of hyper- tension, serum creatinine level 1.5 mg/dL [132.6 mol/L], and cerebrovascular cause of death. Along with terminal donor renal function and cause of donor death, other factors have been reported to affect graft survival, such as long cold ischemic times (CIT) and delayed graft function (DGF). 2–5 With more of these factors coexisting, the relative risk for graft loss increases synergistically. 4 A study using US data from 1995 to 2000 showed that the expanded donor group accounted for 14.8% of transplanted kidneys. They showed a high discard From the King Saud Bin Abdulaziz University for Health Sciences (M.F.S., A.A.S.); Saudi Center for Organ Transplanta- tion (F.A.M.S., B.A., K.E.); and Department of Medicine (H.A.H.), King Abdulaziz Medical City, Riyadh, Saudi Arabia. Address reprint requests to Dr. Mohammed Faisal Shaheen, Demonstrator in Transplant Surgery, King Saud Bin Abdulaziz University for Health Sciences – National Guard Health Affairs, PO Box 22490 - MC 1440, Riyadh 11426, Kingdom of Saudi Arabia. E-mail mohammedfsh@gmail.com © 2010 Published by Elsevier Inc. 0041-1345/10/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2009.12.052 Transplantation Proceedings, 42, 273–276 (2010) 273