title: Long-term outcome of kidney transplantation from elderly living and expanded criteria deceased donors.
abstract: The imbalance between organ demand and supply causes the increasing use of suboptimal donors. The aim of this study is to investigate the survival and allograft function of kidney transplantation from standard (SLD) and elderly living (ELD), standard criteria (SCDD) and expanded criteria deceased (ECDD) donors. All patients transplanted from 1997 to 2005 were investigated according to the donor characteristics. Data were collected retrospectively during the 83.4±43.1 months of follow-up period. ELD was defined as donor age≥60 years. ECDD was defined as UNOS criteria. A total of 458 patients were divided into four groups: SLD (n:191), ELD (n:67), SCDD (n:154), and ECDD (n:46). Seven-year death-censored graft survival in SLD, ELD, SCDD, and ECDD were 81.6%, 64.8%, 84.7%, and 68.3%, respectively (p=0.003). The death-censored graft survival in ELD group was lower than in SLD (p=0.007) and SCDD (p=0.007) groups, while in ECDD group it was lower than in SCDD group (p=0.026). Patient survival was similar. In ECDD group, 83% of total deaths occurred within the first 3 years, mainly due to infections (66.6%) (p<0.05). Estimated glomerular filtration rate (eGFR) was lower in ELD (compared with SLD and SCDD); and ECDD (compared with SCDD) at last visit. In multivariate analysis, ELD, experience of an acute rejection episode and presence of delayed graft function were the independent predictors for death censored graft loss. Transplantation of a suboptimal kidney provides inferior graft survival and function. A higher number of deaths due to infection in the early post-transplant period in the ECDD group are noteworthy.
authors.affiliation: Department of Nephrology, Izmir Tepecik Research and Training Hospital , Izmir , Turkey .
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tanrısev
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Hoşcoşkun
authors.forename: Gülay
authors.initials: G
authors.lastname: Aşçı
authors.forename: Murat
authors.initials: M
authors.lastname: Sözbilen
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Fırat
authors.forename: Muhittin
authors.initials: M
authors.lastname: Ertilav
authors.forename: Mehmet
authors.initials: M
authors.lastname: Özkahya
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Töz
mesh_terms: D000368:Aged; D051799:Delayed Graft Function; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000145:classification / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014421:Turkey / Q000453:epidemiology
keywords: Elderly donor; expanded criteria donor; kidney transplantation; survival