DGF in Kidneys from Older Donors Raise Graft Failure Risk
Sacha De Serres, MD
QUEBEC CITY, QUEBEC—Surgeons should proceed with caution when deciding whether to transplant kidneys from donors older than 60 years, a new study suggests.
The retrospective review showed that, among recipients of kidneys from donors older than 60, , death-censored graft loss was nearly seven times more likely with delayed graft function. “When we think the kidney may suffer from DGF post-transplant, and the donor is above age 60, we might be more careful of accepting the kidney,” said Sacha De Serres, MD, who presented the findings at the Canadian Society of Transplantation's 2012 Annual Meeting. “It's a matter of increasing the pool of kidneys safely. You don't want to discard kidneys, but at the same time you don't want to transplant a kidney that doesn't have a good chance of working.”
Dr. De Serres and his colleagues at the University of Laval in Quebec reviewed the relationship between DGF and long-term outcomes among 657 people who received kidneys from brain-dead donors between January 1, 1990 and July 1, 2005. The median follow-up was 106 months.
DGF occurred in 122 recipients. Patients who received DGF kidneys had a similar average age to those with non-DGF kidneys, and most recipients were male. However, those with DGF kidneys had on average higher body mass indices (26 vs. 25 kg/m2), longer time on dialysis prior to transplantation (37 vs. 26 months), a higher rate of diabetes (21% vs. 13%), a higher rate of induction therapy (30% vs. 14%), and longer warm and cold ischemic times (37 vs. 34 minutes and 25 vs. 20 minutes, respectively).
Donors of DGF kidneys were significantly older than donors of non-DGF kidneys (43 vs. 37 years), had higher serum creatinine levels (84 vs. 76 µmol/L) and significantly lower estimated glomerular filtration rates (90 vs. 104 mL/min.). The characteristics of donors over 60 years of age were similar for those whose kidneys did or did not experience DGF post-transplant.
Furthermore, among recipients of kidneys from donors over 60 years of age whose kidneys did or did not experience post-transplant DGF, the characteristics were similar. The only exception was that those with DGF kidneys had longer cold ischemic time (24 vs. 21 minutes).
In adjusted analyses, among recipients of kidneys from donors aged 60 and older, recipients of DGF kidneys had a 2.67 times increased risk of uncensored graft loss and a 6.98 times increased risk of death-censored graft loss compared with recipients of non-DGF kidneys .
The team also examined death-censored graft loss among DGF kidneys from patients who were or were not expanded-criteria donors (ECDs). Recipients of ECD kidneys had a 3.3 times increased risk of DGF than recipients of non-ECD kidneys.