title: Preemptive kidney transplantation in elderly recipients with kidneys discarded of very old donors: A good alternative.
abstract: BACKGROUND
  The shortage of organs is a major hurdle in kidney transplantation, and one solution to the problem is to extend the age of the donor. However, organs from older donors are often discarded due to the macroscopic appearance of the parenchyma or major vessels. On the other hand, a large number of elderly patients are potential candidates for kidney transplantation, while many kidneys from elderly deceased donors are discarded due to a lack of age-matched recipients. In addition, a large number are often discarded due to the lack of compatible recipients among elderly patients undergoing chronic dialysis. A possible solution to avoid this wastage of kidneys potentially suitable for transplantation could be the performance of preemptive kidney transplantation (PKT) in carefully selected elderly patients. PKT improves graft and patient survival compared to other renal replacement therapy options. There is no information about PKT in elderly patients receiving kidneys from elderly deceased donors.
  
  
  METHODS
  From 2007 to 2012, we performed a prospective observational study comparing 26 elderly patients receiving PKT with a control group of 26 elderly patients receiving a first transplant after prior dialysis.
  
  
  RESULTS
  Mean age of recipients was 74.3±2.9 years and mean age of donors was 73.8±4.1 years. Induction immunosuppression was similar in both groups. Death-censored graft survival was 96% in the PKT group and 68% in the control group (p=0.02), at 5 years after transplantation. Immediate and delayed graft function occurred in 92% and 3.8%, respectively, of patients in the PKT group and 53% and 34.6% of patients in the control group (p=0.005). Acute rejection was significantly more frequent in PKT patients (23.1% vs 3.8%, p=0.043). At the end of follow-up time 35.5±20.1 months, the glomerular filtration rate was similar in both groups (42.2±11.7 vs 41.7±11.2ml/min, p-value=0.72). Patient survival was similar in the two groups.
  
  
  CONCLUSIONS
  Elderly patients with end stage of renal disease non-dialysis may benefit from PKT elderly deceased donors whose kidneys were to be discarded for there are not patients in the waiting list.
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain. Electronic address: emoralesr@senefro.org.
authors: Enrique
authors: E
authors: Morales
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Eduardo
authors: E
authors: Gutiérrez
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Ana
authors: A
authors: Hernández
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Jorge
authors: J
authors: Rojas-Rivera
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Esther
authors: E
authors: Gonzalez
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Eduardo
authors: E
authors: Hernández
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Natalia
authors: N
authors: Polanco
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Manuel
authors: M
authors: Praga
authors: Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain.
authors: Amado
authors: A
authors: Andrés
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D051799:Delayed Graft Function / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D006435:Renal Dialysis; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Discarded organs; Donante anciano; Elderly donor; Elderly recipient; Graft survival; Patient survival; Pre-emptive kidney transplantation; Receptor anciano; Supervivencia del injerto; Supervivencia del paciente; Trasplante renal prediálisis; Órganos desechados