To compare the clinical data of expanded criteria donor (ECD) and standard criteria donor (SCD) kidney transplantation in the same period, and to observe the medium- and long-term curative effect of ECD renal transplantation.

The clinical data of the kidney donors and corresponding recipients from donation after citizen′s death in the 923 Hospital of PLA from January 2008 to June 2018 were retrospectively analyzed. According to whether the donor met the criteria of ECD, the corresponding recipients are divided into ECD group (n=223) and SCD group (n=198). The starting point of observation was the day of transplantation, and the end point of observation was kidney failure, including return to dialysis, retransplantation or death, and the loss of transplant kidney caused by non-immune factors or death which was not caused by transplant kidney failure were not excluded. Wilcoxon signed rank sum test was used to compare non-normal distribution measurement data, and chi-square test was used to compare count data. Kaplan-Meier method was used to draw the survival curve, and the median survival time was calculated and compared by log-rank test. P<0.05 indicated that the difference was statistically significant.

Up to June 2021, the incidence of postoperative acute rejection (AR) in the ECD group and the SCD group was 21.5% (48/223) and 19.7% (39/198), respectively (χ²=0.214, P>0.05). The incidence of AR within 1 year after transplantation was 18.4% (41/223) and 7.6% (15/198), respectively (χ²=10.627, P<0.05). The incidence of pulmonary infection in the ECD group and the SCD group was 43.5% (97/223) and 33.3% (66/198), respectively (χ²=4.567, P<0.05). The incidence of pulmonary infection within 6 months after transplantation was 30.9% (69/223) and 22.7% (45/198), respectively (χ²=3.584, P>0.05). The mortality rates of the ECD group and the SCD group were 9.9% (22/223) and 8.6% (17/198), respectively (χ²=0.1929, P>0.05). The incidence of graft failure in the ECD group and the SCD group was 11.7% (26/223) and 5.1% (10/198), respectively (χ²=5.858, P<0.05). The median renal survival time in the ECD group and the SCD group was 120 and 146 months, respectively (χ²=4.352, P<0.05). The medians of serum creatinine minimum values in the ECD group and the SCD group during follow-up were 120 μmol/L (48-591 μmol/L) and 95 μmol/L (42-630 μmol/L), respectively (Z=-5.967, P<0.05).

It is expected to obtain a better medium- and long-term prognosis in the ECD kidney transplantation through full evaluation, careful choice and individualized treatment.