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.

1. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2021. 14th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2022; 24 (3): 8–31. doi: 10.15825/1995-1191-2022-3-8-31.

2. Metzger RA, Delmonico FL, Feng S, Port FK, Wynn JJ, Merion RM. Expanded criteria donors for kidney transplantation. Am J Transplant. 2003; 3 Suppl 4: 114–125. doi: 10.1034/j.1600-6143.3.s4.11.x.

3. Querard AH, Foucher Y, Combescure C, Dantan E, Larmet D, Lorent M et al. Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis. Transpl Int. 2016 Apr; 29 (4): 403– 415. doi: 10.1111/tri.12736.

4. Barreda Monteoliva P, Redondo-Pachón D, Miñambres García E, Rodrigo Calabia E. Kidney transplant outcome of expanded criteria donors after circulatory death. Nefrologia (Engl Ed). 2022 Mar-Apr; 42 (2): 135–144. doi: 10.1016/j.nefroe.2021.01.005.

5. Sandes-Freitas TV de. Expanded donor criteria in kidney transplantation: a suitable option to increase the donor pool in Brazil? J Bras Nefrol. 2016 Jul-Sep; 38 (3): 273– 274. doi: 10.5935/0101-2800.20160040.

6. Maggiore U, Oberbauer R, Pascual J, Viklicky O, Dudley C, Budde K et al. Strategies to increase the donor pool and access to kidney transplantation: an international perspective. Nephrol Dial Transplant. 2015 Feb; 30 (2): 217–222. doi: 10.1093/ndt/gfu212.

7. Schold JD, Hall YN. Enhancing the expanded criteria donor policy as an intervention to improve kidney allocation: is it actually a «net-zero» model? Am J Transplant. 2010 Dec; 10 (12): 2582–2585. doi: 10.1111/j.16006143.2010.03320.x.

8. Hwang JK, Park SC, Kwon KH, Choi BS, Kim JI, Yang CW et al. Long-term outcomes of kidney transplantation from expanded criteria deceased donors at a single center: comparison with standard criteria deceased donors. Transplant Proc. 2014; 46 (2): 431–436. doi: 10.1016/j.transproceed.2013.11.061.

9. Rouhi AD, Choudhury RA, Hoeltzel GD, Prins K, Yoeli D, Moore HB et al. Uncontrolled donation after cardiac death kidney transplantation: Opportunity to expand the donor pool? Am J Surg. 2023 Jun; 225 (6): 1102–1107. doi: 10.1016/j.amjsurg.2022.12.014.

10. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2023. 16th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2024; 26 (3): 8–31. doi: 10.15825/1995-1191-2024-3-8-31.

11. Eurotransplant International Foundation [Электронный ресурс/Internet]. URL: https://statistics.eurotransplant.org/(дата обращения/date of access: 13.06.2025).

12. www.ont.es/Actividad_de_donación_y_trasplante_España_2023.pdf.

13. Patel K, Brotherton A, Chaudhry D, Evison F, Nieto T, Dabare D, Sharif A. All Expanded Criteria Donor Kidneys are Equal But are Some More Equal Than Others? A Population-Cohort Analysis of UK Transplant Registry Data. Transpl Int. 2023 Sep 4; 36: 11421. doi: 10.3389/ti.2023.11421.

14. Aubert O, Kamar N, Vernerey D, Viglietti D, Martinez F, Duong-Van-Huyen JP et al. Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study. BMJ. 2015 Jul 31; 351: h3557.

15. Gilbert A, Scott D, Stack M, de Mattos A, Norman D, Rehman S et al. Long-standing donor diabetes and pathologic findings are associated with shorter allograft survival in recipients of kidney transplants from diabetic donors. Mod Pathol. 2022 Jan; 35 (1): 128–134. doi: 10.1038/s41379-021-00927-2.

16. Ahmad M, Cole EH, Cardella CJ, Cattran DC, Schiff J, Tinckam KJ, Kim SJ. Impact of deceased donor diabetes mellitus on kidney transplant outcomes: a propensity score-matched study. Transplantation. 2009 Jul 27; 88 (2): 251–260. doi: 10.1097/TP.0b013e3181ac68a9.

17. Kim SM, Ahn S, Min SI, Park D, Park T, Min SK et al. Cold ischemic time is critical in outcomes of expanded criteria donor renal transplantation. Clin Transplant. 2013 Jan-Feb; 27 (1): 132–139. doi: 10.1111/ctr.12034.

18. Johnston TD, Thacker LR, Jeon H, Lucas BA, Ranjan D. Sensitivity of expanded-criteria donor kidneys to cold ischaemia time. Clin Transplant. 2004; 18 Suppl 12: 28–32. doi: 10.1111/j.1399-0012.2004.00214.x.

19. Hall IE, Akalin E, Bromberg JS, Doshi MD, Greene T, Harhay MN et al. Deceased-donor acute kidney injury is not associated with kidney allograft failure. Kidney Int. 2019 Jan; 95 (1): 199–209. doi: 10.1016/j.kint.2018.08.047.

20. Van der Windt DJ, Mehta R, Jorgensen DR, Bou-Samra P, Hariharan S, Randhawa PS et al. Donor acute kidney injury and its effect on 1-year post-transplant kidney allograft fibrosis. Clin Transplant. 2020 Feb; 34 (2): e13770. doi: 10.1111/ctr.13770.

21. Pei J, Cho Y, See YP, Pascoe EM, Viecelli AK, Francis RS et al. Impact of deceased donor with acute kidney injury on subsequent kidney transplant outcomes – an ANZDATA registry analysis. PloS One. 2021 Mar 25; 16 (3): e0249000. doi: 10.1371/journal.pone.0249000.

22. Allen PJ, Chadban SJ, Craig JC, Lim WH, Allen RDM, Clayton PA et al. Recurrent glomerulonephritis after kidney transplantation: risk factors and allograft outcomes. Kidney Int. 2017 Aug; 92 (2): 461–469. doi: 10.1016/j.kint.2017.03.015.

23. Stolyarevich ES, Zhilinskaya TR, Artyukhina LYu, Kim IG, Zaydenov VA, Tomilina NA. Morphological structure of late renal graft dysfunction and its effect for long-term results. Russian Journal of Transplantology and Artificial Organs. 2018; 20 (1): 45–54. [In Russ, English abstract]. doi: 10.15825/1995-11912018-1-45-54.

24. USRDS [Internet]. Annual Data Report. Available at: https://usrds-adr.niddk.nih.gov/. Accessed June 23, 2025.

25. Ko KJ, Kim YH, Kwon KH, Kim MH, Jun KW, Hwang JK et al. Kidney Transplantation Using Expanded-Criteria Deceased Donors: A Comparison With Ideal Deceased Donors and Non-Expanded-Criteria Deceased Donors. Transplant Proc. 2018 Dec; 50 (10): 3222–3227. doi: 10.1016/j.transproceed.2018.05.028.

26. Fang X, Wang Y, Liu R, Zhu C, Wu C, He F et al. Longterm outcomes of kidney transplantation from expanded criteria donors with Chinese novel donation policy: donation after citizens’ death. BMC Nephrol. 2022 Oct 3; 23 (1): 325. doi: 10.1186/s12882-022-02944-y.

27. Foroutan F, Friesen EL, Clark KE, Motaghi S, Zyla R, Lee Y et al. Risk Factors for 1-Year Graft Loss After Kidney Transplantation. Clin J Am Soc Nephrol. 2019 Nov 7; 14 (11): 1642–1650. doi: 10.2215/CJN.05560519.

28. Salguero J, Chamorro L, Gomez-Gomez E, Robles JE, Campos JP. Midterm Outcomes of Kidney Transplantation from Expanded Criteria Donors After Circulatory Death: A Single-Center Retrospective Cohort Study. Exp Clin Transplant. 2023 Jun; 21 (6): 481–486. doi: 10.6002/ect.2023.0076.

29. Hellemans R, Kramer A, De Meester J, Collart F, Kuypers D, Jadoul M et al. Does kidney transplantation with a standard or expanded criteria donor improve patient survival? Results from a Belgian cohort. Nephrol Dial Transplant. 2021 Apr 26; 36 (5): 918–926. doi: 10.1093/ndt/gfab024.