ECD kidneys from cardiac-death donors yield worse outcomes in elderly patients.
SAN FRANCISCO—Elderly recipients of expanded criteria donor (ECD) kidneys have worse outcomes if the organs come from non-beating heart donors rather than brain-dead donors, data suggest.
In recent years, the use of ECD kidneys has become more common in the elderly and is expected to increase further with proposed changes to the allocation of deceased donor organs. The use of ECD kidneys from non-beating heart donors (donation after cardiac death [DCD kidneys]) also is on the rise. Overall, graft failure rates with DCD kidneys and kidneys from standard criteria donors (SCD) are comparable, but whether this is the case for elderly recipients has not been well studied.
Researchers at the University of California in Los Angeles analyzed the outcomes of 30,909 patients aged 60 and older who received deceased donor kidney transplants between 1995 and 2006. Investigators analyzed data from the Organ Procurement and Transplant Network/United Net-work for Organ Sharing (OPTN/UNOS). They compared the results of transplants from four donors groups: 23,117 SCD kidneys; 6,817 ECD kidneys from brain-dead older donors and those with hypertension or slightly decreased kidney function; 178 DCD-ECD kidneys; and 797 DCD-SCD kidneys.
The chances of graft and patient survival were best for patients receiving kidneys from brain-dead SCD donors. Graft and patient survival rates were nearly as good for transplants using DCD-SCD kidneys. The outcomes were not as good for transplants using DCD-ECD kidneys. In this group, the risk of graft loss was 65% higher than for patients who received kidneys from brain-dead ECD donors, according to findings presented here during Renal Week 2007, which is convened by the American Society of Nephrology. The risk of death was nearly twice as high for patients receiving DCD-ECD kidneys, but the investigators observed no significant difference in death-censored graft loss.
Investigator Jagbir Gill, MD, a research scholar at David Geffen School of Medicine at UCLA, said “extreme caution” is required before transplanting DCD kidneys into older patients. “We are probably going to do more and more of these transplants as time goes on, so we need to consider how we allocate these DCDs. We have to have some consistency across centers, and we have to consider what groups they should be used in.”
Also at the conference, another research team reported that kidneys from older deceased donors (aged 50 years and older) transplanted into younger recipients (aged less than 50 years) result in a significantly higher rate of rejection episodes post-transplant. The investigators examined outcomes of 49 renal transplants involving allografts from older deceased donors. Thirty-two kidneys were transplanted into older patients (aged 50 and older) and 17 went to younger recipients. The mean donor age for these recipients was 63.9 and 60.0 years, respectively.
Allograft failure occurred in three elderly recipients but in none of the younger recipients.
In their poster, the authors concluded: “We support the current practice of preferably allocating the elderly kidneys to older recipients.”