title: Strategies for an Expanded Use of Kidneys From Elderly Donors.
abstract: The old-for-old allocation policy used for kidney transplantation (KT) has confirmed the survival benefit compared to remaining listed on dialysis. Shortage of standard donors has stimulated the development of strategies aimed to expand acceptance criteria, particularly of kidneys from elderly donors. We have systematically reviewed the literature on those different strategies. In addition to the review of outcomes of expanded criteria donor or advanced age kidneys, we assessed the value of the Kidney Donor Profile Index policy, preimplantation biopsy, dual KT, machine perfusion and special immunosuppressive protocols. Survival and functional outcomes achieved with expanded criteria donor, high Kidney Donor Profile Index or advanced age kidneys are poorer than those with standard ones. Outcomes using advanced age brain-dead or cardiac-dead donor kidneys are similar. Preimplantation biopsies and related scores have been useful to predict function, but their applicability to transplant or refuse a kidney graft has probably been overestimated. Machine perfusion techniques have decreased delayed graft function and could improve graft survival. Investing 2 kidneys in 1 recipient does not make sense when a single KT would be enough, particularly in elderly recipients. Tailored immunosuppression when transplanting an old kidney may be useful, but no formal trials are available.Old donors constitute an enormous source of useful kidneys, but their retrieval in many countries is infrequent. The assumption of limited but precious functional expectancy for an old kidney and substantial reduction of discard rates should be generalized to mitigate these limitations.
authors.affiliation: 1 Department of Nephrology, Hospital del Mar, Barcelona, Spain. 2 Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Pérez-Sáez
authors.forename: Núria
authors.initials: N
authors.lastname: Montero
authors.forename: Dolores
authors.initials: D
authors.lastname: Redondo-Pachón
authors.forename: Marta
authors.initials: M
authors.lastname: Crespo
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D051799:Delayed Graft Function / Q000209:etiology / Q000517:prevention & control; D046148:Donor Selection; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D010477:Perfusion; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents