Kidney transplantation from expanded criteria donors. The first multicenter cohort study in the Russian Federation

The use of expanded criteria donors (ECDs) is an effective strategy to increase the availability of organs for transplantation. However, in Russia, there have been no large-scale studies evaluating the outcomes of kidney transplantation (KT) from ECDs. In Moscow, through successful implementation of an original organ donation model, considerable experience has been accumulated in managing donors who meet the UNOS expanded criteria for kidney donation. This paper presents the epidemiological characteristics of donors and recipients, as well as the medium-term outcomes of KT from ECDs. The study represents the first multicenter cohort study in the Russian Federation dedicated to kidney transplants from ECDs. The database was developed using systematized donor information from the Moscow Coordination Center for Organ Donation at Botkin Hospital for the period 2021–2022. During this time, 254 donors meeting UNOS expanded criteria underwent organ explantation at 21 hospitals in Moscow. The follow-up period for KT recipients was limited to four years. Recipient survival at 4 years after transplantation was 0.882 [95% CI 0.839–0.927], while overall graft survival (loss from any cause) was 0.806 [95% CI 0.739–0.880] and death-censored graft survival was 0.887 [95% CI 0.825–0.952]. Primary graft function was observed in 61.4% of recipients who received kidneys from ECDs. The medium-term survival rates of both recipients and grafts are acceptable and comparable to those reported in international studies, confirming the safety and effectiveness of expanding donor criteria to increase the number of kidney transplants.