TY - JOUR
T1 - Stretching the limits of renal transplantation in elderly recipients of grafts from elderly deceased donors
AU - Peters-Sengers, Hessel
AU - Berger, Stefan P.
AU - Heemskerk, Martin B.A.
AU - Arashi, Doaaal
AU - Van Der Heide, Jaap J.Homan
AU - Hemke, Aline C.
AU - Ten Berge, Ineke J.M.
AU - Idu, Mirza M.
AU - Betjes, Michiel G.H.
AU - Van Zuilen, Arjan D.
AU - Hilbrands, Luuk B.
AU - De Vries, Aiko P.J.
AU - Nurmohamed, Azam S.
AU - Christiaans, Maarten H.
AU - Van Heurn, L. W.Ernest
AU - De Fijter, Johan W.
AU - Bemelman, Frederike J.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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 agraft fromeitherayoungor elderlydonor, stratifiedbydonortype. 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-yearmortality 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 whoreceivedelderlyDBDkidneys, andapproximately26%of thosewhoreceivedyoungDBDorDCDkidneyshadan EGFR,<30ml/min per 1.73m2 (including primary nonfunction) after 1 year. In conclusion, improving donor selection and preservation is warranted if the allocation of elderly DCD grafts to elderly recipients is to be expanded.
AB - 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 agraft fromeitherayoungor elderlydonor, stratifiedbydonortype. 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-yearmortality 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 whoreceivedelderlyDBDkidneys, andapproximately26%of thosewhoreceivedyoungDBDorDCDkidneyshadan EGFR,<30ml/min per 1.73m2 (including primary nonfunction) after 1 year. In conclusion, improving donor selection and preservation is warranted if the allocation of elderly DCD grafts to elderly recipients is to be expanded.
UR - http://www.scopus.com/inward/record.url?scp=85021407788&partnerID=8YFLogxK
U2 - https://doi.org/10.1681/ASN.2015080879
DO - https://doi.org/10.1681/ASN.2015080879
M3 - Article
C2 - 27729570
SN - 1046-6673
VL - 28
SP - 621
EP - 631
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 2
ER -