Elderly individuals with end-stage kidney disease can successfully receive transplanted kidneys from deceased donors (DD) of similar age and have good survival, according to results from a new Spanish study.
“The use of kidneys from extremely age deceased donors would offer the possibility of transplantation to very old recipients without a detrimental impact on younger candidates in terms of organ allocation,” Jimena Cabrera, MD, of University of the Republic, Montevideo in Uruguay, and colleagues reported a paper published online in Nephrology Dialysis Transplantation.
A total of 138 recipients with a median age of 77.5 years received DD kidneys at a university hospital in Madrid during 2002 to 2015. The donors had a median age of 77 years, with one-fifth of patients aged 80 years or older. Patient survival at 1 and 5 years was 82.1% and 60.1%, respectively, despite a high comorbidity burden, including chronic heart disease (45.7%), diabetes mellitus (32.6%), and chronic obstructive pulmonary (13.8%). Death-censored graft survival was 95.6% and 93.1%, respectively. Diabetic nephropathy was the only factor significantly predicting a nearly 5-fold higher risk for death-censored graft loss. Primary graft non-function occurred in 8.0%.
Biopsy-proven acute rejection occurred in 15.2% and was associated with a significant 4-fold higher risk for death at 1 year.
Post-transplant infections developed in 70.3% of patients. Infection was the leading cause of death in 46% of cases.
Dr Cabrera and colleagues said that to their knowledge, their study is the first to analyze long-term outcomes in a cohort of extremely elderly recipients—with substantial comorbidity—from similarly aged deceased donors.
The investigators suggest that patients aged 75 years or older who have no absolute contraindications such as severe underlying conditions or recent malignancy should be considered for transplantation.
“Donor–recipient age matching prevents elderly subjects from competing on the waiting list with younger recipients for grafts from young donors,” the investigators concluded.
Cabrera J, Fernandez-Ruiz M, Trujillo H, et al. Kidney transplantation in the extremely elderly from extremely aged deceased donors: a kidney for each age [published online April 1, 2020]. Nephrol Dial Transplant 35:687–696. doi: 10.1093/ndt/gfz293