Older Donors Are Suitable
Five-year pancreas and kidney graft survival rates are 80.9% and 72.2%.
Simultaneous pancreas-kidney (SPK) transplants using organs from older donors are associated with reasonable graft survival and improved patient survival compared with waiting for a transplant from any donor, according to a study.
Transplant programs may need to re-examine their policies concerning older donors, the researchers say.
“The growing competition for the limited organ supply is forcing us to critically examine our criteria for donor acceptance,” said lead researcher Krista Lentine, MD, assistant professor of medicine in the division of nephrology and the Cen-ter for Outcomes Research at Saint Louis University School of Medicine in Missouri. “We need to understand what characteristics define acceptable rather than ideal donors. To date, older donor age has been a particular barrier to donor acceptance for SPK transplant.”
From 1995 to 2005, the number of patients on an SPK transplant waiting list in the United States had increased by more than 150%, but the number of transplants increased by only 21%.
Dr. Lentine and her colleagues studied 8,850 patients who received an SPK transplant from 1994 to 2005. A total of 776 (8.8%) grafts were from older donors (aged 45 years and older). The researchers compared graft and patient survival in patients who received organs from donors younger than 45 years with those who received organs from donors aged 45 years and older. They also compared patient survival in the transplanted groups with subjects who remained on a waiting list. The younger donors had a mean age of 24.6 years (range 1-44 years); the older donors had a mean age of 49 years (range 45-74 years).
Five-year, death-censored kidney and pancreas survivals were 86.8% and 80.9%, respectively, with the use of younger donors compared with 80.9% and 72.2%, respectively, with the use of older donors. Five-year patient survival was 84.5% in those who received organs from younger donors and 81% in patients who received organs from older donors. Patients who remained on a waiting list had a five-year survival of 45.4%.
After adjusting for demographic traits, comorbidities, dialysis duration, and listing year, SPK transplants using younger and older donors independently predicted lower mortality compared with continued waiting. Recipients of younger and older donor organs had estimated 75% and 72% reduced mortality risks compared with patients who remained on a waiting list, Dr. Lentine said.
“From a population-level perspective, we believe these data demonstrate that reasonable graft survival rates can be achieved with use of older donors and, importantly, that use of older donors can be lifesaving,” Dr. Lentine said. “From an individual recipient's perspective, of course, everyone would prefer to receive an ideal organ. But additional waiting time for a ‘better offer' depreciates the survival advantage of a higher quality organ due to the high risk of death on the waiting list.”
Dr. Lentine's group is trying to characterize the patient-level and regional predictors of reduced access to early young donor transplants to help understand who may benefit most from use of an older donor.