Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors

Hessel Peters-Sengers*, Stefan P. Berger, Martin B. A. Heemskerk, Doaa al Arashi, Jaap J. Homan van der Heide, Aline C. Hemke, Ineke J. M. ten Berge, Mirza M. Idu, Michiel G. H. Betjes, Arjan D. van Zuilen, Luuk B. Hilbrands, Aiko P. J. de Vries, Azam S. Nurmohamed, Maarten H. Christiaans, L. W. Ernest van Heurn, Johan W. de Fijter, Frederike J. Bemelman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

45 Citations (Web of Science)

Abstract

An increasing number of elderly patients (>= 65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (>= 18 years) who received a first DBD or DCD kidney during 2002-2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type. In multiple logistic regression analysis, elderly recipients of elderly DCD kidneys experienced more delayed graft function and acute rejection than did elderly recipients of young DBD kidneys (odds ratios 10.43 [95% confidence interval (95% CI), 5.75 to 18.91] and 2.78 [95% CI, 1.35 to 5.73], respectively). In Cox regression analysis, elderly recipients of elderly DCD kidneys had a 5-year mortality risk higher than that of elderly recipients of young DBD kidneys (hazard ratio, 1.86; 95% CI, 1.15 to 3.02). Elderly recipients of elderly kidneys had a 5-year mortality rate comparable to that of waitlisted elderly patients remaining on dialysis. Among elderly recipients, 63.8% of those who received elderly DCD kidneys, 45.5% of those who received elderly DBD kidneys, and approximately 26% of those who received young DBD or DCD kidneys had an eGFR

Original languageEnglish
Pages (from-to)621-631
Number of pages11
JournalJournal of the American Society of Nephrology
Volume28
Issue number2
DOIs
Publication statusPublished - Feb 2017

Keywords

  • EXPANDED-CRITERIA DONORS
  • KIDNEY-TRANSPLANTATION
  • CARDIAC DEATH
  • CIRCULATORY DEATH
  • SURVIVAL BENEFIT
  • OLDER DONORS
  • COLD-STORAGE
  • AGE
  • DONATION
  • OUTCOMES

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