title: The combined risk of donor quality and recipient age: higher-quality kidneys may not always improve patient and graft survival.
abstract: BACKGROUND
  The Kidney Donor Profile Index (KDPI) is a more precise donor organ quality metric replacing age-based characterization of donor risk. Little prior attention has been paid on the outcomes of lower-quality kidneys transplanted into elderly recipients. Although we have previously shown that immunological risks associated with older organs are attenuated by advanced recipient age, it remains unknown whether risks associated with lower-quality KDPI organs are similarly reduced in older recipients.
  
  
  METHODS
  Donor organ quality as measured by the KDPI was divided into quintiles (very high, high, medium, low, and very low quality), and Cox proportional hazards was used to assess graft and recipient survival in first-time adult deceased donor transplant recipients by recipient age.
  
  
  RESULTS
  In uncensored graft survival analysis, recipients older than 69 years had demonstrated comparable outcomes if they received low-quality kidneys compared to medium-quality kidneys. Death-censored analysis demonstrated no increased relative risk when low-quality kidneys were transplanted into recipients aged 70 to 79 years (hazard ratio [HR], 1.11; P=0.19) or older than 79 years (HR, 1.08; P=0.59). In overall survival analysis, elderly recipients gained no relative benefit from medium-quality kidneys over low-quality kidneys (70-79 years: HR, 1.03, P=0.51; >79 years: HR, 1.08; P=0.32).
  
  
  CONCLUSIONS
  Our analysis demonstrates that transplanting medium-quality kidneys into elderly recipients does not provide significant advantage over low-quality kidneys.
authors.affiliation: 1 Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. 2 Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 3 Division of Transplant Surgery, Brigham and Women's Hospital, Boston, MA. 4 Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA. 5 Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT. 6 Address correspondence to: Stefan G. Tullius, M.D., Ph.D., Division of Transplant Surgery, Brigham and Women's Hospital, 75 Francis Street, PBB215, Boston, MA 02140.
authors.forename: Roland A
authors.initials: RA
authors.lastname: Hernandez
authors.forename: Sayeed K
authors.initials: SK
authors.lastname: Malek
authors.forename: Edgar L
authors.initials: EL
authors.lastname: Milford
authors.forename: Samuel R G
authors.initials: SR
authors.lastname: Finlayson
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Tullius
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors; D014481:United States / Q000453:epidemiology; D055815:Young Adult