title: A Lifetime of Allograft Function with Kidneys from Older Donors.
abstract: Strategies to increase expanded criteria donor (ECD) transplantation are needed. We quantified the extent to which ECD kidneys provide recipients with a lifetime of allograft function by determining the difference between patient survival and death-censored allograft survival (graft survival). Initial analyses compared 5-year outcomes in the Eurotransplant Senior Program (European) and the United States Renal Data System. Among European recipients ≥65 years, patient survival exceeded graft survival, and ECD recipients returned to dialysis for an average of 5.2 months after transplant failure. Among United States recipients ≥60 years, graft survival exceeded patient survival. Although patient survival in elderly recipients in the United States was low (49% at 5 years), the average difference in patient survival at 10 years in elderly recipients in the United States with an ECD versus non-ECD transplant was only 7 months. The probability of patient survival with a functioning allograft at 5 years was higher with ECD transplantation within 1 year after activation to the waiting list than with delayed non-ECD transplantation ≥3 years after activation to the waiting list. Subsequent analyses demonstrated that ECD transplants do not provide a lifetime of allograft function in recipients <50 years in the United States. These findings should encourage ECD transplantation in patients ≥60 years, demonstrate that rapid ECD transplantation is superior to delayed non-ECD transplantation, and challenge the policy in the United States of allowing patients <50 years to receive an ECD transplant.
authors: Division of Nephrology, University of British Columbia, Vancouver, Canada;
authors: Caren
authors: C
authors: Rose
authors: Division of Nephrology, Charité University Medicine, Berlin, Germany;
authors: Elke
authors: E
authors: Schaeffner
authors: Division of Nephrology, Charité University Medicine, Berlin, Germany;
authors: Ulrich
authors: U
authors: Frei
authors: Division of Nephrology, University of British Columbia, Vancouver, Canada; Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; and.
authors: Jagbir
authors: J
authors: Gill
authors: Division of Nephrology, University of British Columbia, Vancouver, Canada; Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; and Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts jgill@providencehealth.bc.ca.
authors: John S
authors: JS
authors: Gill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D064591:Allografts; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards; D014481:United States; D055815:Young Adult
keywords: cadaver organ transplantation; expanded criteria donors; health policy; survival; transplantation