Differential outcomes of expanded-criteria donor renal allografts according to recipient age.
OBJECTIVE
Expanded-criteria donor (ECD) kidneys are used to expand the number of deceased-donor kidney transplants, often for elderly recipients. This study sought to determine whether older recipients had significantly worse outcomes from receiving ECD kidneys and whether outcomes of ECD versus standard-criteria donor (SCD) kidneys differed in younger recipients.


METHODS
This is a single-center, retrospective review of all primary deceased-donor kidney transplantations performed between 2000 and 2005. Group 1 consisted of patients ≥60 years of age (n=189) who received an ECD (n=96) or an SCD (n=93) kidney. Group 2 consisted of patients 40-59 years of age (n=370) who received an ECD (n=105) or an SCD (n=265) kidney.


RESULTS
Older recipients (group 1) who received ECD kidneys demonstrated significantly shortened 5-year actuarial patient and graft survival rates compared with older recipients of SCD allografts. Group 1 ECD recipients also had significantly worse outcomes than younger (group 2) ECD recipients. In multivariate analysis, ECD kidneys remained an independent predictor of poorer outcome in group 1.


CONCLUSIONS
Morbidity and mortality were increased in elderly recipients of ECD kidneys. These findings may have implications in kidney allocation policy developments that encourage placement of ECD kidneys for older recipients.
Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-7375, USA. mezrich@surgery.wisc.edu
Joshua D
JD
Mezrich
John D
JD
Pirsch
Luis A
LA
Fernandez
David P
DP
Foley
Janet M
JM
Bellingham
Jon S
JS
Odorico
Glen E
GE
Leverson
Alejandro
A
Munoz-Del-Rio
Hans W
HW
Sollinger
Dixon B
DB
Kaufman
Anthony M
AM
D'Alessandro
D000328:Adult; D000367:Age Factors; D000368:Aged; D002102:Cadaver; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome