title: Long-Term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age.
abstract: Extended criteria donors represent nowadays a main resource for kidney transplantation, and recovery criteria are becoming increasingly inclusive. However, the limits of this approach are not clear as well as the effects of extreme donor ages on long-term kidney transplantation outcomes. To address these issues, we performed a retrospective study on extended criteria donor kidney transplantation.
  
  
  
  In total, 647 consecutive extended criteria donor kidney transplantations performed over 11 years (2003-2013) were included. Donor, recipient, and procedural variables were classified according to donor age decades (group A, 50-59 years old [n=91]; group B, 60-69 years old [n=264]; group C, 70-79 years old [n=265]; and group D, ≥80 years old [n=27]). Organs were allocated in single- or dual-kidney transplantation after a multistep evaluation including clinical and histologic criteria. Long-term outcomes and main adverse events were analyzed among age groups and in either single- or dual-kidney transplantation. Kidney discard rate incidence and causes were evaluated.
  
  
  
  Median follow-up was 4.9 years (25th; 75th percentiles: 2.7; 7.6 years); patient and graft survival were comparable among age groups (5-year patient survival: group A, 87.8%; group B, 88.1%; group C, 88.0%; and group D, 90.1%; P=0.77; graft survival: group A, 74.0%; group B, 74.2%; group C, 75.2%; and group D, 65.9%; P=0.62) and between dual-kidney transplantation and single-kidney transplantation except for group D, with a better survival for dual-kidney transplantation (P=0.04). No difference was found analyzing complications incidence or graft function over time. Kidney discard rate was similar in groups A, B, and C (15.4%, 17.7%, and 20.1%, respectively) and increased in group D (48.2%; odds ratio, 5.1 with A as the reference group; 95% confidence interval, 2.96 to 8.79).
  
  
  
  Discard rate and long-term outcomes are similar among extended criteria donor kidney transplantation from donors ages 50-79 years old. Conversely, discard rate was strikingly higher among kidneys from octogenarian donors, but appropriate selection provides comparable long-term outcomes, with better graft survival for dual-kidney transplantation.
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Maria
authors.initials: M
authors.lastname: Messina
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Davide
authors.initials: D
authors.lastname: Diena
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Sergio
authors.initials: S
authors.lastname: Dellepiane
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Guzzo
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Luca
authors.initials: L
authors.lastname: Lo Sardo
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fop
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Giuseppe P
authors.initials: GP
authors.lastname: Segoloni
authors.affiliation: Immunogenetics and Transplant Biology Service, "Città della Salute e della Scienza di Torino," Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amoroso
authors.affiliation: Immunogenetics and Transplant Biology Service, "Città della Salute e della Scienza di Torino," Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Magistroni
authors.affiliation: Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
authors.forename: Luigi
authors.initials: L
authors.lastname: Biancone
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D046148:Donor Selection / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome
keywords: Aged, 80 and over; Follow-Up Studies; Graft Survival; Health Resources; Humans; Incidence; Retrospective Studies; Tissue Donors; Transplants; cadaver organ transplantation; discard rate; elderly; graft survival; kidney; kidney transplantation; octogenarian donors; organ allocation