• Expanded-criteria donors
• Kidney transplantation
• Outcomes
• Sirolimus
• Survival.

Introduction
The use of organs from marginal donors (ECD) has become increasingly frequent because the growing organ shortage. The aim of the study was to evaluate the long-term outcome of ECD kidney recipients (KTR) treated with SRL de novo as an alternative to CNI.
Patients and Methods
Monocentric longitudinal retrospective study of 75 KTR from ECD, from 2000 to 2005, with a follow-up of 127 ± 52 months. SRL group = 25 pts treated with SRL + MMF + steroid, CNI group = 50 pts treated with CNI + MMF + steroid. The two KTR groups were similar for age (58 ± 7 vs 57 ± 7 years) and sex.
Results
No significant differences were found at 10 years for the overall survival of the patient (84% in the two groups) and of the graft (80% vs 92%, SRL vs CNI group). The renal function over time, the incidence of DGF and acute rejection were also comparable. There were no differences in the prevalence of infections, neoplasia, cardiovascular events and NODAT in the SRL group compared to CNI group. 6 patients dropped out in the SRL group for SRL related adverse effects.
Conclusions
The study confirms the excellent results of transplantation from ECD. The use of SRL can be considered a valid alternative to CNI for KTR from ECD, with good renal transplantation outcome and overall survival.