title: Survival Benefit From Kidney Transplantation Using Kidneys From Deceased Donors Aged ≥75 Years: A Time-Dependent Analysis.
abstract: Patients with end-stage renal disease have longer survival after kidney transplantation than they would by remaining on dialysis; however, outcome with kidneys from donors aged ≥75 years and the survival of recipients of these organs compared with their dialysis counterparts with the same probability of obtaining an organ is unknown. In a longitudinal mortality study, 2040 patients on dialysis were placed on a waiting list, and 389 of them received a first transplant from a deceased donor aged ≥75 years. The adjusted risk of death and survival were calculated by non-proportional hazards analysis with being transplanted as a time-dependent effect. Projected years of life since placement on the waiting list was almost twofold higher for transplanted patients. Nonproportional adjusted risk of death after transplantation was 0.44 (95% confidence interval [CI] 0.61-0.32; p < 0.001) in comparison with those that remained on dialysis. Stratifying by age, adjusted hazard ratios for death were 0.17 (95% CI 0.47-0.06; p = 0.001) for those aged <65 years, 0.56 (95% CI 0.92-0.34; p = 0.022) for those aged 65-69 years and 0.82 (95% CI 1.28-0.52; p = 0.389) for those aged ≥70 years. Although kidney transplantation from elderly deceased donors is associated with reduced graft survival, transplanted patients have lower mortality than those remaining on dialysis.
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.|Institut Mar d'Investigacions Médiques, Barcelona, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pérez-Sáez
authors.affiliation: Organització Catalana de Trasplantaments, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Arcos
authors.affiliation: Organització Catalana de Trasplantaments, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Comas
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.|Institut Mar d'Investigacions Médiques, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Lloveras
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.|Institut Mar d'Investigacions Médiques, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pascual
mesh_terms: D000367:Age Factors; D000368:Aged; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists
keywords: clinical research/practice; donors and donation; donors and donation: donor evaluation; kidney transplantation/nephrology; organ acceptance; organ procurement and allocation