title: Optimizing utilization of kidneys from deceased donors over 60 years: five-year outcomes after implementation of a combined clinical and histological allocation algorithm.
abstract: This 5 year observational multicentre study conducted in the Nord Italian Transplant programme area evaluated outcomes in patients receiving kidneys from donors over 60 years allocated according to a combined clinical and histological algorithm. Low-risk donors 60-69 years without risk factors were allocated to single kidney transplant (LR-SKT) based on clinical criteria. Biopsy was performed in donors over 70 years or 60-69 years with risk factors, allocated to Single (HR-SKT) or Dual kidney transplant (HR-DKT) according to the severity of histological damage. Forty HR-DKTs, 41 HR-SKTs and 234 LR-SKTs were evaluated. Baseline differences generally reflected stratification and allocation criteria. Patient and graft (death censored) survival were 90% and 92% for HR-DKT, 85% and 89% for HR-SKT, 88% and 87% for LR-SKT. The algorithm appeared user-friendly in daily practice and was safe and efficient, as demonstrated by satisfactory outcomes in all groups at 5 years. Clinical criteria performed well in low-risk donors. The excellent outcomes observed in DKTs call for fine-tuning of cut-off scores for allocation to DKT or SKT in high-risk patients.
authors.affiliation: Kidney - Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
authors.forename: Elisa Sefora
authors.initials: ES
authors.lastname: Pierobon
authors.affiliation: Kidney - Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
authors.forename: Pierobon Elisa
authors.initials: PE
authors.lastname: Sefora
authors.forename: Silvio
authors.initials: S
authors.lastname: Sandrini
authors.forename: Sandrini
authors.initials: S
authors.lastname: Silvio
authors.forename: Nicola
authors.initials: N
authors.lastname: De Fazio
authors.forename: De Fazio
authors.initials: de F
authors.lastname: Nicola
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossini
authors.forename: Rossini
authors.initials: R
authors.lastname: Giuseppe
authors.forename: Iris
authors.initials: I
authors.lastname: Fontana
authors.forename: Fontana
authors.initials: F
authors.lastname: Iris
authors.forename: Luigino
authors.initials: L
authors.lastname: Boschiero
authors.forename: Boschiero
authors.initials: B
authors.lastname: Luigino
authors.forename: Maria
authors.initials: M
authors.lastname: Gropuzzo
authors.forename: Gropuzzo
authors.initials: G
authors.lastname: Maria
authors.forename: Eliana
authors.initials: E
authors.lastname: Gotti
authors.forename: Gotti
authors.initials: G
authors.lastname: Eliana
authors.forename: Donato
authors.initials: D
authors.lastname: Donati
authors.forename: Donati
authors.initials: D
authors.lastname: Donato
authors.forename: Enrico
authors.initials: E
authors.lastname: Minetti
authors.forename: Minetti
authors.initials: M
authors.lastname: Enrico
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Gandolfo
authors.forename: Gandolfo Maria
authors.initials: GM
authors.lastname: Teresa
authors.forename: Anna
authors.initials: A
authors.lastname: Brunello
authors.forename: Brunello
authors.initials: B
authors.lastname: Anna
authors.forename: Carmelo
authors.initials: C
authors.lastname: Libetta
authors.forename: Libetta
authors.initials: L
authors.lastname: Carmelo
authors.forename: Antonio
authors.initials: A
authors.lastname: Secchi
authors.forename: Secchi
authors.initials: S
authors.lastname: Antonio
authors.forename: Stefano
authors.initials: S
authors.lastname: Chiaramonte
authors.forename: Chiaramonte
authors.initials: C
authors.lastname: Stefano
authors.forename: Paolo
authors.initials: P
authors.lastname: Rigotti
authors.forename: Rigotti
authors.initials: R
authors.lastname: Paolo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001706:Biopsy; D002102:Cadaver; D051799:Delayed Graft Function; D005260:Female; D006085:Graft Survival; D006801:Humans; D007558:Italy; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: DKT; ECD; allocation algorithm; graft survival; kidney transplantation