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Abstract
Background Elderly patients are the fastest-growing group in need of renal transplantation. This study puts focus on renal transplant recipients in their 80th year or longer at time of engraftment. Is there evidence to support an absolute upper age limit for renal transplantation? Methods Recipients in their 80th year or longer, transplanted between 1983 and 2015, were included. Data were retrieved from the Norwegian Renal Registry in the end of October 2015. Graft and patient survivals were compared with recipients aged 70 to 79 years at transplantation. Results Forty-seven patients older than 79 years were transplanted in the defined period. Median age 80.1 years, 81% were men. Median time on dialysis before transplantation was 18.5 months. All patients received an allograft from a deceased donor (median donor age, 61.8 years). In the death-censored graft survival model, there was no statistical difference between the groups. We found improved patient and graft survivals after introduction of mycophenolate mofetil and induction with basiliximab. Patients transplanted before 2000 had increased risk of death compared with those transplanted after 2000 (hazard ratio, 3.2; 95% confidence interval, 1.2-8.7). Median uncensored graft survival for patients transplanted after the year 2000 was 5.0 year (95% confidence interval, 2.4-7.6). Median patient survival was 5.0 years (3.1-6.9) and 5-year patient survival was 55%. Conclusions Age by itself should not be an absolute contraindication against renal transplantation. An estimated 5-year survival rate of 55% post-engraftment for an 80-year-old patient is in our opinion more than acceptable. The authors reveal an estimated 5 years survival rate of 55% postengraftment for an 80 years old patient with end-stage renal disease. In carefully selected octogenarians, kidney transplantation has an acceptable estimated 5 years survival rate in their opinion.
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Messina M, Diena D, Dellepiane S, Guzzo G, Lo Sardo L, Fop F, Segoloni GP, Amoroso A, Magistroni P, Biancone L. Long-Term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age. Clin J Am Soc Nephrol 2017; 12:323-331. [PMID: 27979977 PMCID: PMC5293338 DOI: 10.2215/cjn.06550616] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/19/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES 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. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Maria Messina
- 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
| | - Davide Diena
- 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
| | - Sergio Dellepiane
- 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
| | - Gabriella Guzzo
- 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
| | - Luca Lo Sardo
- 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
| | - Fabrizio Fop
- 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
| | - Giuseppe P. Segoloni
- 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
| | - Antonio Amoroso
- Immunogenetics and Transplant Biology Service, “Città della Salute e della Scienza di Torino,” Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paola Magistroni
- Immunogenetics and Transplant Biology Service, “Città della Salute e della Scienza di Torino,” Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luigi Biancone
- 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
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