Prognostic factors for kidney allograft survival in the Eurotransplant Senior Program.
BACKGROUND
The shortage of organ donors has led to the introduction of the Eurotransplant Senior Program (ESP) to optimize the allocation of kidneys from elderly donors by age-matching. In the face of a rapidly aging population, identification of prognostic factors for kidney allograft survival within the ESP population will be of enormous significance.


METHODS
Donor and recipient data from 89 patients transplanted under the ESP protocol between 1999 and 2007 were retrospectively analyzed. Data were correlated with initial graft function, graft survival, acute rejection episodes, serum creatinine levels, glomerular filtration rates, and patient survival using univariate and multivariate analysis. Maximum follow-up was 5 years.


RESULTS
Cold ischemia time (CIT) >16 hours, body mass index (BMI) ≥25 kg/m(2), and kidney re-transplantation were significant risk factors for delayed graft function (DGF). Odds ratio for primary non-function was significantly increased with prolonged CIT, BMI ≥25 kg/m(2), and duration of renal replacement therapy >69 months. CIT >15 h, DGF, and kidney re-transplantation were associated with poor graft survival (P<0.05).


CONCLUSIONS
Risk reduction (e.g., aiming at CIT <15 h) and close surveillance of patients at risk appear to be crucial for allograft survival in the ESP.
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
Ralf
R
Bahde
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
Thorsten
T
Vowinkel
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
Julia
J
Unser
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
Christoph
C
Anthoni
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
Jens Peter
JP
Hölzen
Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, Muenster University Hospital, Muenster, Germany.
Barbara
B
Suwelack
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
Norbert
N
Senninger
Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany.
Heiner H
HH
Wolters
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D051799:Delayed Graft Function / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents