Long-term outcomes and discard rate of kidneys by decade of extended criteria donor age

Maria Messina, Davide Diena, Sergio Dellepiane, Gabriella Guzzo, Luca Lo Sardo, Fabrizio Fop, Giuseppe P. Segoloni, Antonio Amoroso, Paola Magistroni, Luigi Biancone

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

Background and objectives Extended criteria donors represent nowadays a main resource for kidney transplantation, and recovery criteria are becoming increasingly inclusive.However, the limits of this approach are not clear aswell as the effects of extreme donor ages on long-termkidney transplantation outcomes. To address these issues, we performed a retrospective study on extended criteria donor kidney transplantation. Design, setting, participants, & measurements In total, 647 consecutive extended criteria donor kidney transplantations performed over 11 years (2003-2013)were included. Donor, recipient, and procedural variables were classified according to donor age decades (group A, 50-59 years old [n=91]; group B, 60-69 years old [n=264]; group C, 70-79 years old [n=265]; and group D, ≥ 80 years old [n=27]). Organs were allocated in single-or dual-kidney transplantation after a multistep evaluation including clinical and histologic criteria. Long-term outcomes and main adverse events were analyzed among age groups and in either single-or dual-kidney transplantation. Kidney discard rate incidence and causes were evaluated. Results Median follow-up was 4.9 years (25th; 75th percentiles: 2.7; 7.6 years); patient and graft survival were comparable among age groups (5-year patient survival: group A, 87.8%; group B, 88.1%; group C, 88.0%; and group D, 90.1%; P=0.77; graft survival: group A, 74.0%; group B, 74.2%; group C, 75.2%; and group D, 65.9%; P=0.62) and between dual-kidney transplantation and single-kidney transplantation except for group D, with a better survival for dual-kidney transplantation (P=0.04). No difference was found analyzing complications incidence or graft function over time. Kidney discard rate was similar in groups A, B, and C (15.4%, 17.7%, and 20.1%, respectively) and increased in group D (48.2%; odds ratio, 5.1 with A as the reference group; 95% confidence interval, 2.96 to 8.79). Conclusions Discard rate and long-term outcomes are similar among extended criteria donor kidney transplantation from donors ages 50-79 years old. Conversely, discard rate was strikingly higher among kidneys from octogenarian donors, but appropriate selection provides comparable long-term outcomes, with better graft survival for dual-kidney transplantation.

Original languageEnglish
Pages (from-to)323-331
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number2
DOIs
StatePublished - 2017
Externally publishedYes

Keywords

  • Aged, 80 and over
  • Cadaver organ transplantation
  • Discard rate
  • Elderly
  • Follow-up studies
  • Graft survival
  • Graft survival
  • Health resources
  • Humans
  • Incidence
  • Kidney
  • Kidney transplantation
  • Octogenarian donors
  • Organ allocation
  • Retrospective studies
  • Tissue donors
  • Transplants

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