title: Old-for-old kidney allocation allows successful expansion of the donor and recipient pool.
abstract: Allocation of kidneys from donors older than 64 years to recipients older than 64 years was started in 1999 to improve use of older donor kidneys. Kidneys are allocated locally without HLA-matching to keep cold ischemia short. We compared survival and rejection rates in elderly patients allocated in the old-for-old program (ESP) to patients aged 60 years and older based on HLA-matching, expected ischemia and waiting time (ETKAS). The 69 ESP patients were older (67.9 +/- 2.5 vs. 63.9 +/- 2.9 years), had older donors (71.2 +/- 3.9 vs. 44.6 +/- 14.5 years) and more HLA-mismatches (4.2 +/- 1.2 vs. 1.6 +/- 1.7) than the 71 ETKAS patients, while ischemia was shorter (7.8 +/- 3.4 vs. 14.2 +/- 5.5 h). ESP and ETKAS had similar graft (1-year: 83.6% vs. 86.9%) and patient survival (85.2% vs. 89.5%). With the introduction of ESP, use of older recipients and donors rose from less than 2% to 16% and 11%, respectively. Incidence of acute rejections was significantly higher in the ESP group (1 year: 43.2% vs. 27.4%) and significantly correlated with the degree of HLA-matching. Introduction of old-for-old allocation allows successful expansion of the donor and recipient pool without affecting patient and graft survival. HLA-matching should not be ignored, as the risk of acute rejection in elderly patients is substantial.
authors.affiliation: Department of Nephrology, Campus Mitte, Berlin, Germany. Lutz.Fritsche@charite.de
authors.forename: Lutz
authors.initials: L
authors.lastname: Fritsche
authors.forename: Jan
authors.initials: J
authors.lastname: Hörstrup
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.forename: Petra
authors.initials: P
authors.lastname: Reinke
authors.forename: Markus
authors.initials: M
authors.lastname: Giessing
authors.forename: Stefan
authors.initials: S
authors.lastname: Tullius
authors.forename: Stefan
authors.initials: S
authors.lastname: Loening
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Hans-Hellmut
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frei
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents