title: Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors.
abstract: An increasing number of elderly patients (≥65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (≥18 years) who received a first DBD or DCD kidney during 2002-2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type. In multiple logistic regression analysis, elderly recipients of elderly DCD kidneys experienced more delayed graft function and acute rejection than did elderly recipients of young DBD kidneys (odds ratios 10.43 [95% confidence interval (95% CI), 5.75 to 18.91] and 2.78 [95% CI, 1.35 to 5.73], respectively). In Cox regression analysis, elderly recipients of elderly DCD kidneys had a 5-year mortality risk higher than that of elderly recipients of young DBD kidneys (hazard ratio, 1.86; 95% CI, 1.15 to 3.02). Elderly recipients of elderly kidneys had a 5-year mortality rate comparable to that of waitlisted elderly patients remaining on dialysis. Among elderly recipients, 63.8% of those who received elderly DCD kidneys, 45.5% of those who received elderly DBD kidneys, and approximately 26% of those who received young DBD or DCD kidneys had an eGFR<30 ml/min per 1.73 m2(including primary nonfunction) after 1 year. In conclusion, improving donor selection and preservation is warranted if the allocation of elderly DCD grafts to elderly recipients is to be expanded.
authors.affiliation: Departments of Nephrology and h.peterssengers@amc.uva.nl.
authors.forename: Hessel
authors.initials: H
authors.lastname: Peters-Sengers
authors.affiliation: Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Berger
authors.affiliation: Netherlands Organ Transplant Registry, Dutch Transplant Foundation, Leiden, The Netherlands.
authors.forename: Martin B A
authors.initials: MB
authors.lastname: Heemskerk
authors.affiliation: Departments of Nephrology and.
authors.forename: Doaa
authors.initials: D
authors.lastname: Al Arashi
authors.affiliation: Departments of Nephrology and.
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Homan van der Heide
authors.affiliation: Netherlands Organ Transplant Registry, Dutch Transplant Foundation, Leiden, The Netherlands.
authors.forename: Aline C
authors.initials: AC
authors.lastname: Hemke
authors.affiliation: Departments of Nephrology and.
authors.forename: Ineke J M
authors.initials: IJ
authors.lastname: Ten Berge
authors.affiliation: Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mirza M
authors.initials: MM
authors.lastname: Idu
authors.affiliation: Department of Nephrology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arjan D
authors.initials: AD
authors.lastname: van Zuilen
authors.affiliation: Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Luuk B
authors.initials: LB
authors.lastname: Hilbrands
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Aiko P J
authors.initials: AP
authors.lastname: de Vries
authors.affiliation: Department of Nephrology, Vrije University Medical Center, Amsterdam, The Netherlands; and.
authors.forename: Azam S
authors.initials: AS
authors.lastname: Nurmohamed
authors.affiliation: Departments of Nephrology and.
authors.forename: Maarten H
authors.initials: MH
authors.lastname: Christiaans
authors.affiliation: Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: L W
authors.initials: LW
authors.lastname: Ernest van Heurn
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Johan W
authors.initials: JW
authors.lastname: de Fijter
authors.affiliation: Departments of Nephrology and.
authors.forename: Frederike J
authors.initials: FJ
authors.lastname: Bemelman
mesh_terms: D000367:Age Factors; D000368:Aged; D002102:Cadaver; D046148:Donor Selection; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009927:Tissue and Organ Procurement / Q000592:standards*
keywords: Donation after brain death; Donation after circulatory death; Elderly donors; Elderly recipients; Eurotransplant Senior Program; kidney transplantation