Expanded donor criteria in kidney transplantation: a suitable option to increase the donor pool in Brazil?

Correspondence to: Tainá Veras de Sandes-Freitas. Universidade Federal do Ceará. Departamento de Medicina Clínica. Rua Prof. Costa Mendes, no 1608, 4o Andar. Rodolfo Teófilo, Fortaleza, CE, Brazil. CEP: 60430-140. E-mail: taina.sandes@gmail. com Because of the disproportion between supply and demand for kidneys for transplantation, the use of expanded criteria donors (ECD) significantly increased over the past years1. Recently, a Brazilian center reported that 35% of deceased donors transplants are performed with ECD2, similar to European countries and significantly higher than US reports (17%)1. Evidences show that ECD transplantation provides better patient survival when compared to remaining on dialysis1. However, discard rates of these organs are still substantial1. To improve the binary classification on ECD or standard criteria donor (SCD), Kidney Donor Risk Index (KDRI) and Profile Index (KDPI) was proposed. This scoring system is based on multiple donor and transplant characteristics in a graduated evaluation of donor quality3. In this issue of BJN, Mota and colleagues4 present results from a retrospective comparison of 24 renal allograft recipients who received ECD kidneys and 231 who received SCD. As a result, patients in ECD group presented inferior renal function (glomerular filtration rate at 12 months: 56.8 vs. 76.9 mL/min, p = 0.001). There was no difference in 1-year death censored graft survival (90.5 vs. 94.6%, p = 0,452). Graft survival was also similar when authors compared kidneys with KDPI above 85% to those below 85% (88.2 vs. 90.8%, p = 0.769). Of note, only 37.5% of ECD kidneys were submitted to preimplantation biopsies and this did not affect the good results in a short term. In fact, the role Expanded donor criteria in kidney transplantation: a suitable option to increase the donor pool in Brazil?