Outcome of kidney transplantation from senior deceased donors: a single centre study
BACKGROUND: Addressing the current demographic development, the efficacy and safety of kidney transplantations from very senior donors needs to be carefully evaluated. The aim of this study was to analyse patient and graft outcomes of kidney allograft recipients stratified by donor age.
METHODS: We retrospectively investigated n = 491 patients from a prospective, observational renal transplant cohort. Patients with kidneys from very old donors (n = 75, aged >70 years), elderly donors (n = 158, between 60–70 years), and regular donors (n = 258, aged <60 years) were investigated. The primary outcome was death-censored graft survival within the predefined donor age groups.
RESULTS: Overall, n = 57 death-censored graft losses occurred. Graft loss was proportionally highest in the very old donor group (n = 11/75), but this did not reach statistical significance when compared to the elderly (14/158) and regular donor groups (32/258); (p = 0.37). Kaplan-Meier analysis demonstrated that 3-year/5-year death-censored graft survival in the very old donor group was 96%/86% and did not differ from the other age groups (p = 0.44). Median estimated glomerular filtration rate (eGFR), calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (in ml/min/1.73 m2 of body surface) 12 months post-transplant did not differ between the elderly donor and very old donor groups (p = 0.53). However, patients who received regular donor kidneys had higher median eGFR compared to recipients in both the elderly and very old donor groups (p <0.0001). During follow-up, 31% of patients developed at least one acute rejection episode. Time-to-event analysis demonstrated no difference in occurrence of any acute rejection event across all three groups (p = 0.11).
CONCLUSIONS: This study demonstrates that kidney transplantation from carefully selected very old donors seems a valid option with reasonable short- and mid-term outcomes.
- Cohen B, Smits JM, Haase B, Persijn G, Vanrenterghem Y, Frei U. Expanding the donor pool to increase renal transplantation. Nephrol Dial Transplant. 2005 Jan;20(1):34–41. 10.1093/ndt/gfh506
- Rao PS, Ojo A. The alphabet soup of kidney transplantation: SCD, DCD, ECD—fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol. 2009 Nov;4(11):1827–31. 10.2215/CJN.02270409
- Rosengard BR, Feng S, Alfrey EJ, Zaroff JG, Emond JC, Henry ML, et al. Report of the Crystal City meeting to maximize the use of organs recovered from the cadaver donor. Am J Transplant. 2002 Sep;2(8):701–11. 10.1034/j.1600-6143.2002.20804.x
- Tanriover B, Mohan S, Cohen DJ, Radhakrishnan J, Nickolas TL, Stone PW, et al. Kidneys at higher risk of discard: expanding the role of dual kidney transplantation. Am J Transplant. 2014 Feb;14(2):404–15. 10.1111/ajt.12553
- Messina M, Diena D, Dellepiane S, Guzzo G, Lo Sardo L, Fop F, et al. Long-Term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age. Clin J Am Soc Nephrol. 2017 Feb;12(2):323–31. 10.2215/CJN.06550616
- Kuhn C, Lang BM, Lörcher S, Karolin A, Binet I, Beldi G, et al. Outcome of kidney transplantation from very senior donors in Switzerland - a national cohort study. Transpl Int. 2021 Apr;34(4):689–99. 10.1111/tri.13836
- Ojo AO, Hanson JA, Meier-Kriesche HU, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001 Mar;12(3):589–97. 10.1681/ASN.V123589
- 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;351:h3557. 10.1136/bmj.h3557
- Merion RM, Ashby VB, Wolfe RA, Distant DA, Hulbert-Shearon TE, Metzger RA, et al. Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA. 2005 Dec;294(21):2726–33. 10.1001/jama.294.21.2726
- Chavalitdhamrong D, Gill J, Takemoto S, Madhira BR, Cho YW, Shah T, et al. Patient and graft outcomes from deceased kidney donors age 70 years and older: an analysis of the Organ Procurement Transplant Network/United Network of Organ Sharing database. Transplantation. 2008 Jun;85(11):1573–9. 10.1097/TP.0b013e31817059a1
- Frei U, Noeldeke J, Machold-Fabrizii V, Arbogast H, Margreiter R, Fricke L, et al. Prospective age-matching in elderly kidney transplant recipients—a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant. 2008 Jan;8(1):50–7. 10.1111/j.1600-6143.2007.02014.x
- Peters-Sengers H, Berger SP, Heemskerk MB, Al Arashi D, Homan van der Heide JJ, Hemke AC, et al. Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors. J Am Soc Nephrol. 2017 Feb;28(2):621–31. 10.1681/ASN.2015080879
- Querard AH, Le Borgne F, Dion A, Giral M, Mourad G, Garrigue V, et al. Propensity score-based comparison of the graft failure risk between kidney transplant recipients of standard and expanded criteria donor grafts: toward increasing the pool of marginal donors. Am J Transplant. 2018 May;18(5):1151–7. 10.1111/ajt.14651
- Echterdiek F, Schwenger V, Döhler B, Latus J, Kitterer D, Heemann U, et al. Kidneys From Elderly Deceased Donors-Is 70 the New 60? Front Immunol. 2019 Nov;10:2701. 10.3389/fimmu.2019.02701
- Arcos E, Pérez-Sáez MJ, Comas J, Lloveras J, Tort J, Pascual J; Catalan Renal Registry*. Assessing the Limits in Kidney Transplantation: Use of Extremely Elderly Donors and Outcomes in Elderly Recipients. Transplantation. 2020 Jan;104(1):176–83. 10.1097/TP.0000000000002748
- Bielmann D, Hönger G, Lutz D, Mihatsch MJ, Steiger J, Schaub S. Pretransplant risk assessment in renal allograft recipients using virtual crossmatching. Am J Transplant. 2007 Mar;7(3):626–32. 10.1111/j.1600-6143.2007.01667.x
- Bächler K, Amico P, Hönger G, Bielmann D, Hopfer H, Mihatsch MJ, et al. Efficacy of induction therapy with ATG and intravenous immunoglobulins in patients with low-level donor-specific HLA-antibodies. Am J Transplant. 2010 May;10(5):1254–62. 10.1111/j.1600-6143.2010.03093.x
- Amico P, Hirt-Minkowski P, Hönger G, Gürke L, Mihatsch MJ, Steiger J, et al. Risk stratification by the virtual crossmatch: a prospective study in 233 renal transplantations. Transpl Int. 2011 Jun;24(6):560–9. 10.1111/j.1432-2277.2011.01235.x
- Wehmeier C, Hönger G, Cun H, Amico P, Hirt-Minkowski P, Georgalis A, et al. Donor Specificity but Not Broadness of Sensitization Is Associated With Antibody-Mediated Rejection and Graft Loss in Renal Allograft Recipients. Am J Transplant. 2017 Aug;17(8):2092–102. 10.1111/ajt.14247
- Haas M, Sis B, Racusen LC, Solez K, Glotz D, Colvin RB, et al.; Banff meeting report writing committee. Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant. 2014 Feb;14(2):272–83. 10.1111/ajt.12590
- Loupy A, Haas M, Solez K, Racusen L, Glotz D, Seron D, et al. The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology. Am J Transplant. 2017 Jan;17(1):28–41. 10.1111/ajt.14107
- Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999 Dec;341(23):1725–30. 10.1056/NEJM199912023412303
- Fritsche L, Hörstrup J, Budde K, Reinke P, Giessing M, Tullius S, et al. Old-for-old kidney allocation allows successful expansion of the donor and recipient pool. Am J Transplant. 2003 Nov;3(11):1434–9. 10.1046/j.1600-6135.2003.00251.x
- Giessing M, Budde K, Fritsche L, Slowinski T, Tuerk I, Schoenberger B, et al. “Old-for-old” cadaveric renal transplantation: surgical findings, perioperative complications and outcome. Eur Urol. 2003 Dec;44(6):701–8. 10.1016/s0302-2838(03)00380-4 10.1016/S0302-2838(03)00380-4
- Moers C, Kornmann NS, Leuvenink HG, Ploeg RJ. The influence of deceased donor age and old-for-old allocation on kidney transplant outcome. Transplantation. 2009 Aug;88(4):542–52. 10.1097/TP.0b013e3181b0fa8b