Spanish consensus document for acceptance
and rejection of kidneys from expanded
criteria donors
Lled o-Garc ıa E, Riera L, Passas J, Paredes D, Morales JM, S anchez-
Escuredo A, Burgos-Revilla FJ, de Andr es Belmonte A,
Oppenheimer F, Rodr ıguez-Ferrero ML, Sol e M, Matesanz R,
Valent ın M, Pascual J. Spanish consensus document for acceptance
and rejection of kidneys from expanded criteria donors.
Abstract: In the recent years, more than 60% of available deceased
donors are either older than 50 yr or have significant vascular
comorbidities. This makes the acceptance and rejection criteria of renal
allografts very rigorous, especially in cases of younger recipients, and at
the same time encourages live donations. In our country, there is a lack
of homogeneity in the percentages of use of expanded criteria donor
(ECD) allografts between the different autonomous communities.
Furthermore, the criteria vary greatly, and in some cases, great
importance is given to the biopsy while in others very little. In this study,
we present a unified and homogenous criteria agreed upon by consensus
of a 10-member Panel representing major scientific societies related to
renal transplantation in Spain. The criteria are to be used in accepting
and/or rejecting kidneys from the so-called ECDs. The goal was to
standardize the use of these organs, to optimize the results, and most
importantly to provide for the maximum well being of our patients.
Finally, we believe that after taking into account the Panel’s thorough
review of specific scientific literature, this document will be adaptable to
other national renal transplant programmes.
E. Lled
o-Garc ıa
a
, L. Riera
a
,
J. Passas
a
, D. Paredes
a
,
J. M. Morales
b
, A. S
anchez-
Escuredo
b
, F. J. Burgos-Revilla
b
,
A. de Andr
es Belmonte
c
,
F. Oppenheimer
c
, M. L. Rodr ıguez-
Ferrero
c
, M. Sol
e
d
, R. Matesanz
e
,
M. Valent ın
e
and J. Pascual
c
a
Spanish Urological Association,
b
Spanish
Transplant Society,
c
Spanish Society of
Nephrology,
d
Spanish Society of Pathologists
and
e
National Transplant Organization
(O.N.T.), Spain
Key words: consensus document – expanded
criteria donor kidneys – kidney transplantation
Corresponding author: Enrique Lled o-Garc ıa,
MD, PhD, Urology Dept-Hospital General
Universitario Gregorio Mara~ n on, c/ Doctor
Esquerdo, 46 - 28007 Madrid-Spain
Tel.: 34915868158;
e-mail: Elledo.hgugm@salud.madrid.org
Clinical Transplantation – Clin Transpl – ISSN:
1878-5492.
Conflict of interest: None.
Accepted for publication 5 August 2014
Kidney transplantation offers superior patient sur-
vival quality of life benefits and has proven to be
cost-effective compared with dialysis (1, 2). How-
ever, the supply of organs from living and deceased
donors has been far below the worldwide demand
over the last few years (3, 4). The prevalence of
patients with end-stage renal disease (ESRD)
reached the highest number in our history in 2010,
with 1039.4 per million population (pmp); 47.1%
of these were transplant patients, maintaining the
remaining 52.9% in the different dialysis modali-
ties. Assuming that 20% of the new patients com-
ing to dialysis are candidates for transplantation,
we found a need for more than 26 transplants pmp
per year to be able to eliminate the waiting list (5).
These data are not unique to Spain, but we face a
universal problem, with similar incidences of renal
disease in the neighboring countries (ERA/EDTA
Registry 2008) (6).
The term expanded criteria donor (ECD) was
coined in 2002 (7). Such donors are defined as
those aged ≥60 yr and between 50 and 60 yr with
at least two of the following criteria: history of
hypertension, serum creatinine levels greater than
1.5 mg/dL, or cerebrovascular accident as a cause
of death (8). The controversy over the use of the
ECD has remained open for as long as different
multicenter studies support the idea that these
kidneys have poorer long-term survival rates than
those of standard kidneys. Graft survival adjusted
1
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Clin Transplant 2014 DOI: 10.1111/ctr.12434
Clinical Transplantation