Elderly Kidney Transplant Recipients Fare Better with Younger Donors

Recipients aged 65 years and older who receive kidneys from donors in the same age group have a higher risk of death and delayed graft function.
Recipients aged 65 years and older who receive kidneys from donors in the same age group have a higher risk of death and delayed graft function.

PHILADELPHIA—Elderly kidney transplant recipients have worse survival odds if they receive organs from elderly rather than younger individuals who donate their kidneys following cardiac or brain death, study findings presented at the 2015 American Transplant Congress suggest.

In addition, elderly recipients who receive elderly donation-after-cardiac-death (DCD) kidneys have a greater risk of graft loss and worse renal function.

Using the Dutch Organ Transplantation Registry, Stefan P. Berger, MD, a transplant nephrologist at University Medical Center Groningen in The Netherlands, and colleagues, analyzed patient and graft survival and renal function of elderly renal transplant recipients (aged 65 years and older) who received a DCD or donation-after-brain-death (DBD) kidneys from a donor aged 65 years and older. They compared outcomes with the outcomes of DCD or DBD kidneys from donors younger than 65 years transplanted into elderly recipients.

Compared with elderly recipients of DBD kidneys from younger donors (reference group), elderly recipients of DCD and DBD kidneys from elderly donors had a 2.2 and 1.7 times increased risk of death, respectively, in adjusted analyses. Transplantation of elderly DCD kidneys was associated with a 1.75 times higher 5-year crude graft loss risk compared with the reference group. Additionally, results showed that 63.8% of elderly recipients of elderly DCD kidneys had an estimated glomerular filtration rate below 30 mL/min/1.73 m2 at 1 year post-transplant compared with 26% of the reference group, a significant difference between the groups.

Dr. Berger's team noted that 19% of all Dutch deceased-donor kidneys from 2011 to 2013 were from elderly donors, and these accounted for 63% of Dutch deceased-donor kidneys transplanted into elderly recipients.

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