Marginal Kidneys Benefit Older Recipients
They result in five-year patient survival similar to that of ideal organs
The death-censored graft survival was no different in the two groups, meaning a lot of patients in the marginal kidney group were dying with an intact graft function, said lead investigator Roshan Mainali, MD, a nephrology fellow at the Geisinger Medical Center in Danville, Pa. So they didn't die from the kidney failure. They died from heart attack or stroke, as we expect in elderly people. He presented study findings during Renal Week 2007.
He and his colleagues compared renal transplant outcomes of recipients aged 50 years and older who received organs from deceased marginal kidney donors (MKD) or ideal kidney donors (IKD). All patients received basiliximab induction followed by a regimen that included cyclosporine microemulsion, myco-phenolate mofetil, and prednisone.
The investigators defined MKD as either expanded criteria donors (based on the United Network for Organ Sharing definition) or non-heart beating donors. Forty-six patients received an IKD kidney and
33 patients received an MKD kidney. The patients had a mean age of 62 years (range, 50-77 years), and 60% were male.
The researchers assessed the two groups for graft survival, patient survival, and estimated glomerular filtration rate (eGFR). The researchers noted that both groups had a similar prevalence of smoking, hypertension, and left ventricular systolic dysfunction, but the MKD group had significantly higher rates of diabetes mellitus (DM) and coronary artery disease (CAD).
The MKD group had a significantly lower eGFR than the IKD group during all five years of follow-up, but the eGFR remained stable in both groups during the study period. The five-year death-censored graft survival rate was 72% in the IKD group and 67% in the MKD group, a nonsignificant difference between groups. Five-year patient survival was 67% in the IKD group and 48% in the MKD group, a difference that was not statistically significant.
If clinicians select the right patient, it doesn't really matter whether you give them a marginal or an ideal kidney, Dr Mainali said.
“We think it is a good idea to give the marginal kidneys to older adults, who have a shorter life expectancy,” he told Renal & Urology News. “We are seeing that many of them are dying with an intact graft. So it is a rational use of these organs, which are in such short supply.”