Organs from donors aged 70 and older associated with worse outcomes.

TORONTO—Transplantation of kidneys from deceased donors aged 70 years or older is associated with a high relative risk of graft loss or death, according to researchers.

Consequently, they believe kidneys from older expanded criteria donors (ECDs) should not be transplanted into younger patients.

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“Age is the most confounding factor for graft outcomes in general, and also among expanded criteria donors,” said lead researcher Suphamai Bunnapradist, MD, director of research at the Kidney Transplant Research Center, David Geffen School of Medicine, University of California in Los Angeles.

“The standard practice has been to offer ECD kidneys to either patients older than 40 with co-morbid conditions or anyone over 50. But we should consider increasing the lower cut-off age of recipients to 60 when the ECD is older than 60; that is our current clinical practice.”

Dr. Bunnapradist and his colleagues identified 9,580 ECD single-kidney-only transplants performed in the United States between 2000 and 2005; 601 (6.3%) of these kidneys were from donors aged 70 years or older. Twenty-five percent of these older donors’ kidneys were placed in recipients aged 41-60 years.

These recipients were at 48% higher relative risk of death or graft loss compared with recipients who received organs from donors aged 50-69 years. Recipients aged 50-69 years were at 37% higher relative risk of death and 32% higher relative risk of functional graft loss than if they received a kidney from an ECD aged 50-69. Patients who were African American, had a BMI less than 28 kg/m2, and had been on dialysis for no more than three years were significantly more likely to receive an ECD kidney from someone 70 years or older than from a younger donor.

Investigators reported findings here at the 2008 American Transplant Congress and published the study in Transplantation (2008;85:1573-1579).