title: Mortality among Younger and Older Recipients of Kidney Transplants from Expanded Criteria Donors Compared with Standard Criteria Donors.
abstract: OBJECTIVE
  The quality and age of donor organs are known to have a major effect on patient and graft outcomes, but it is uncertain whether this association is uniform for all recipients. We aimed to determine whether the use of expanded criteria deceased donor (ECD) kidneys for transplantation compared with standard criteria deceased donor (SCD) kidneys has a different association with survival in younger (age <60 years old) compared with older (age ≥60 years old) recipients.
  
  
  METHODS
  Using data from the Australian and New Zealand Dialysis and Transplant Registry (1997-2009), we compared the risk of all-cause mortality and death with functioning graft among younger and older recipients who had received either an SCD or an ECD kidney using the adjusted Cox proportional hazard models.
  
  
  RESULTS
  In total, 3822 patients were transplanted between 1997 and 2009. Over a follow-up period of 21,249 person-years (a median duration of 5.3 years [interquartile range, 2.22-8.6 years]), 567 recipients (n=385 for those age <60 years old; n=182 for those age ≥60 years old) died. Recipient age was an effect modifier between donor types, all-cause mortality, and death with functioning graft (P values for interaction were 0.05 and 0.04, respectively). In younger recipients, there was an excess risk of all-cause mortality (adjusted hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.23 to 1.97) and death with functioning graft (adjusted HR, 1.72; 95% CI, 1.28 to 2.29) after transplantation with ECD kidneys compared with SCD kidneys, but there was no statistically significant association among older recipients (adjusted HR, 1.11; 95% CI, 0.80 to 1.54 and adjusted HR, 1.30; 95% CI, 0.89 to 1.89, respectively). This excess risk was largely caused by death from cardiovascular disease.
  
  
  CONCLUSIONS
  There was an excess risk of all-cause mortality and death with functioning graft when younger recipients were transplanted with ECD kidneys compared with SCD kidneys. These findings suggest that caution is needed in allocating ECD kidneys to younger recipients.
authors.affiliation: Department of Medicine, Queen Mary Hospital, Hong Kong; Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia;
authors.forename: Maggie K M
authors.initials: MK
authors.lastname: Ma
authors.affiliation: Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Renal Medicine University of Western Sydney, New South Wales, Australia;
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia; Sydney School of Public Health, University of Sydney, New South Wales, Australia; and.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Russ
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia; Sydney School of Public Health, University of Sydney, New South Wales, Australia; and.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia; Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Sydney School of Public Health, University of Sydney, New South Wales, Australia; and germaine.wong@health.nsw.gov.au.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors
keywords: cardiovascular diseases; death; follow-up studies; humans; kidney donation; mortality; renal dialysis; renal transplantation; risk; tissue donors