Maria Messina1, Davide Diena1, Sergio Dellepiane1, Gabriella Guzzo1, Luca Lo Sardo1, Fabrizio Fop1, Giuseppe P Segoloni1, Antonio Amoroso2, Paola Magistroni2, Luigi Biancone3. 1. Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and. 2. Immunogenetics and Transplant Biology Service, "Città della Salute e della Scienza di Torino," Department of Medical Sciences, University of Turin, Turin, Italy. 3. Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and luigi.biancone@unito.it.
Abstract
BACKGROUND AND OBJECTIVES: Extended criteria donors represent nowadays a main resource for kidney transplantation, and recovery criteria are becoming increasingly inclusive. However, the limits of this approach are not clear as well as the effects of extreme donor ages on long-term kidney transplantation outcomes. To address these issues, we performed a retrospective study on extended criteria donor kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 647 consecutive extended criteria donor kidney transplantations performed over 11 years (2003-2013) were included. Donor, recipient, and procedural variables were classified according to donor age decades (group A, 50-59 years old [n=91]; group B, 60-69 years old [n=264]; group C, 70-79 years old [n=265]; and group D, ≥80 years old [n=27]). Organs were allocated in single- or dual-kidney transplantation after a multistep evaluation including clinical and histologic criteria. Long-term outcomes and main adverse events were analyzed among age groups and in either single- or dual-kidney transplantation. Kidney discard rate incidence and causes were evaluated. RESULTS: Median follow-up was 4.9 years (25th; 75th percentiles: 2.7; 7.6 years); patient and graft survival were comparable among age groups (5-year patient survival: group A, 87.8%; group B, 88.1%; group C, 88.0%; and group D, 90.1%; P=0.77; graft survival: group A, 74.0%; group B, 74.2%; group C, 75.2%; and group D, 65.9%; P=0.62) and between dual-kidney transplantation and single-kidney transplantation except for group D, with a better survival for dual-kidney transplantation (P=0.04). No difference was found analyzing complications incidence or graft function over time. Kidney discard rate was similar in groups A, B, and C (15.4%, 17.7%, and 20.1%, respectively) and increased in group D (48.2%; odds ratio, 5.1 with A as the reference group; 95% confidence interval, 2.96 to 8.79). CONCLUSIONS: Discard rate and long-term outcomes are similar among extended criteria donor kidney transplantation from donors ages 50-79 years old. Conversely, discard rate was strikingly higher among kidneys from octogenarian donors, but appropriate selection provides comparable long-term outcomes, with better graft survival for dual-kidney transplantation.
BACKGROUND AND OBJECTIVES: Extended criteria donors represent nowadays a main resource for kidney transplantation, and recovery criteria are becoming increasingly inclusive. However, the limits of this approach are not clear as well as the effects of extreme donor ages on long-term kidney transplantation outcomes. To address these issues, we performed a retrospective study on extended criteria donor kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 647 consecutive extended criteria donor kidney transplantations performed over 11 years (2003-2013) were included. Donor, recipient, and procedural variables were classified according to donor age decades (group A, 50-59 years old [n=91]; group B, 60-69 years old [n=264]; group C, 70-79 years old [n=265]; and group D, ≥80 years old [n=27]). Organs were allocated in single- or dual-kidney transplantation after a multistep evaluation including clinical and histologic criteria. Long-term outcomes and main adverse events were analyzed among age groups and in either single- or dual-kidney transplantation. Kidney discard rate incidence and causes were evaluated. RESULTS: Median follow-up was 4.9 years (25th; 75th percentiles: 2.7; 7.6 years); patient and graft survival were comparable among age groups (5-year patient survival: group A, 87.8%; group B, 88.1%; group C, 88.0%; and group D, 90.1%; P=0.77; graft survival: group A, 74.0%; group B, 74.2%; group C, 75.2%; and group D, 65.9%; P=0.62) and between dual-kidney transplantation and single-kidney transplantation except for group D, with a better survival for dual-kidney transplantation (P=0.04). No difference was found analyzing complications incidence or graft function over time. Kidney discard rate was similar in groups A, B, and C (15.4%, 17.7%, and 20.1%, respectively) and increased in group D (48.2%; odds ratio, 5.1 with A as the reference group; 95% confidence interval, 2.96 to 8.79). CONCLUSIONS: Discard rate and long-term outcomes are similar among extended criteria donor kidney transplantation from donors ages 50-79 years old. Conversely, discard rate was strikingly higher among kidneys from octogenarian donors, but appropriate selection provides comparable long-term outcomes, with better graft survival for dual-kidney transplantation.
Authors: I Gandolfini; C Buzio; P Zanelli; A Palmisano; E Cremaschi; A Vaglio; G Piotti; L Melfa; G La Manna; G Feliciangeli; M Cappuccilli; M P Scolari; I Capelli; L Panicali; O Baraldi; S Stefoni; A Buscaroli; L Ridolfi; A D'Errico; G Cappelli; D Bonucchi; E Rubbiani; A Albertazzi; A Mehrotra; P Cravedi; U Maggiore Journal: Am J Transplant Date: 2014-08-25 Impact factor: 8.086
Authors: Stefan G Tullius; Huong Tran; Indira Guleria; Sayeed K Malek; Nicholas L Tilney; Edgar Milford Journal: Ann Surg Date: 2010-10 Impact factor: 12.969
Authors: Akinlolu O Ojo; Julie A Hanson; Herwig-Ulf Meier-Kriesche; Chike N Okechukwu; Robert A Wolfe; Alan B Leichtman; Lawrence Y Agodoa; Bruce Kaplan; Friedrich K Port Journal: J Am Soc Nephrol Date: 2001-03 Impact factor: 10.121
Authors: B Tanriover; S Mohan; D J Cohen; J Radhakrishnan; T L Nickolas; P W Stone; D S Tsapepas; R J Crew; G K Dube; P R Sandoval; B Samstein; E Dogan; R S Gaston; J N Tanriover; L E Ratner; M A Hardy Journal: Am J Transplant Date: 2014-02 Impact factor: 8.086
Authors: Maria E Hollmen; Lauri E Kyllönen; Kaija A Inkinen; Martti L T Lalla; Jussi Merenmies; Kaija T Salmela Journal: Crit Care Date: 2011-05-05 Impact factor: 9.097
Authors: Sumit Mohan; Mariana C Chiles; Rachel E Patzer; Stephen O Pastan; S Ali Husain; Dustin J Carpenter; Geoffrey K Dube; R John Crew; Lloyd E Ratner; David J Cohen Journal: Kidney Int Date: 2018-05-05 Impact factor: 10.612
Authors: Tomohisa Matsunaga; Maximilian J Roesel; Andreas Schroeter; Yao Xiao; Hao Zhou; Stefan G Tullius Journal: Curr Opin Organ Transplant Date: 2022-08-09 Impact factor: 2.269