title: A paired survival analysis comparing hemodialysis and kidney transplantation from deceased elderly donors older than 65 years.
abstract: BACKGROUND
  Kidney transplantation from deceased donors aged 65 years or older is associated with suboptimal patient and graft survival. In large registries, survival is longer after kidney transplantation than when remaining on dialysis. However, whether recipients of these old grafts survive longer than their dialysis counterparts is unknown.
  
  
  METHODS
  We retrospectively assessed the outcomes of 5,230 recipients of first deceased donor grafts transplanted during the period of 1990 to 2010 in Catalonia, 915 of whom received grafts from donors 65 years or older. In a match-pair analysis, we aimed to pair each of 915 eligible cases with one control (1:1 ratio). Each pair had the same characteristics at the time of entering dialysis program: age, sex, primary renal disease, period of dialysis onset, and cardiovascular comorbidities. We found 823 pairs.
  
  
  RESULTS
  Patient survival of 823 recipients of elderly donors was significantly higher than that of their 823 matched dialysis waitlisted nontransplanted partners (91.6%, 74.5%, and 55.5% vs. 88.8%, 44.2%, and 18.1%, respectively at 1, 5, and 10 years; P<0.001). The probability of death after the first year was similar (8.1% transplant vs 10.3% dialysis; P=0.137); however, analyzing the whole period, the adjusted proportional risk of death was 2.66 (95% confidence interval, 2.21-3.20) times higher for patients remaining on dialysis than for transplanted patients (P<0.001).
  
  
  CONCLUSIONS
  Our study demonstrates that despite the fact that kidney transplantation from elderly deceased donors is associated with reduced graft and patient survival, their paired counterpart patients remaining on dialysis have a risk of death 2.66 times higher.
authors.affiliation: 1 Department of Nephrology, Hospital del Mar, Passeig Maritim, Barcelona, Spain. 2 Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Passeig Taulat, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lloveras
authors.forename: Emma
authors.initials: E
authors.lastname: Arcos
authors.forename: Jordi
authors.initials: J
authors.lastname: Comas
authors.forename: Marta
authors.initials: M
authors.lastname: Crespo
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors