1
|
Hiramitsu T, Himeno T, Hasegawa Y, Futamura K, Okada M, Matsuoka Y, Goto N, Ichimori T, Narumi S, Takeda A, Kobayashi T, Uchida K, Watarai Y. Impact of Age 70 years or Older on Donors for Living-Donor Kidney Transplantation. Kidney Int Rep 2024; 9:1321-1332. [PMID: 38707796 PMCID: PMC11069014 DOI: 10.1016/j.ekir.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Kidney transplantation (KT) involving elderly living kidney donors (LKDs) is becoming more frequent because of a profound organ shortage. The efficacy of KT involving grafts obtained from LKDs aged 70 years or older has been reported. However, the safety of donor nephrectomy in LKDs aged 70 years or older, including that associated with changes in the estimated glomerular filtration rate (eGFR), has not been investigated. This study investigated the outcomes of LKDs aged 70 years or older after donor nephrectomy. Methods This single-center, retrospective cohort study included 1226 LKDs who underwent donor nephrectomy between January 2008 and December 2020. LKDs were stratified into the following age groups: 30 to 49 years (244 LKDs), 50 to 69 years (803 LKDs), and 70 to 89 years (179 LKDs). Surgical outcomes, postoperative eGFR changes, end-stage renal disease (ESRD) rates, and mortality rates were compared among these groups. Results No significant difference in surgical outcomes was identified among the groups. LKDs aged 70 to 89 years experienced the lowest eGFR changes at all time points and the lowest eGFR improvement; however, ESRD was not identified in any group during the observation period. Mortality was the highest among LKDs aged 70 to 89 years compared to the other age groups. Conclusion Surgical outcomes, eGFR changes, and ESRD incidences can support the safety of donor nephrectomy in LKDs aged 70 years or older. Considering the advanced age, the high mortality rates in LKDs aged 70 years or older could be considered acceptable.
Collapse
Affiliation(s)
- Takahisa Hiramitsu
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Tomoki Himeno
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Yuki Hasegawa
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Manabu Okada
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Yutaka Matsuoka
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Norihiko Goto
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Toshihiro Ichimori
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Department of Transplant and Endocrine Surgery, Nagoya, Aichi, Japan
| |
Collapse
|
2
|
Echterdiek F, Schwenger V, Döhler B, Latus J, Kitterer D, Heemann U, Süsal C. Kidneys From Elderly Deceased Donors-Is 70 the New 60? Front Immunol 2019; 10:2701. [PMID: 31827468 PMCID: PMC6890834 DOI: 10.3389/fimmu.2019.02701] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/04/2019] [Indexed: 01/26/2023] Open
Abstract
There is a growing shortage of kidney donors leading to extended transplant waiting times associated with increased mortality. To expand the donor pool, clinicians nowadays regularly accept organs from elderly donors, including those aged ≥70 years. There is only limited and conflicting data whether kidneys from these elderly donors allow for satisfactory allograft outcome rates. To asses this question, the 5-year death censored graft survival of 116,870 adult first deceased donor kidney allograft recipients that were transplanted at European centers between 1997 and 2016 and reported to the “Collaborative Transplant Study” were analyzed using Kaplan–Meier analysis and country stratified Cox regression. The combinations of the two transplant periods 1997–2006 and 2007–2016 with the donor age categories 18–49, 50–59, 60–69, and ≥70 years were considered. From 1997–2006 to 2007–2016, the median donor age increased from 50 to 55 years and the proportion of kidneys from ≥60-year-old donors rose from 24.1 to 38.8%. At the same time, the proportion of kidneys from ≥70-year-old donors more than doubled (6.7 vs. 15.4%). Between 1997–2006 and 2007–2016, the 5-year graft survival improved in all donor age categories. During 2007–2016, the 5-year death censored graft survival of kidneys from ≥70-year-old donors was comparable to that of kidneys from 60 to 69-year-old donors during 1997–2006. This was true both for younger recipients (18–64 years) and older recipients (≥65 years). Among the younger recipients, 45–64-year-old recipients showed the best death censored graft survival rates for kidneys from old donors. In the country-stratified Cox regression analysis, compared to the reference of grafts from 18 to 49-year-old donors, the hazard ratio for grafts from ≥70-year-old donors during 2007–2016 was 1.92, exactly the same as the hazard ratio for grafts from 60 to 69-year-old donors during 1997–2006. Our analysis indicates that within only one further decade (1997–2006 vs. 2007–2016) the 5-year death censored graft survival of kidneys from ≥70-year old donors improved to the level of kidneys from 60 to 69-year-old donors in the previous decade.
Collapse
Affiliation(s)
| | - Vedat Schwenger
- Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joerg Latus
- Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
| | - Daniel Kitterer
- Department of Nephrology, Klinikum Stuttgart, Stuttgart, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
3
|
Ozen M, Gunduz M, Topcuoglu P, Toprak SK, Dalva K, Gurman G, Ilhan O. The effect of age on peripheral stem cell mobilization in healthy donors, single center experience. J Clin Apher 2016; 32:16-20. [PMID: 26958783 DOI: 10.1002/jca.21457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/16/2016] [Accepted: 02/16/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE Peripheral stem cell transplantation is used as a life-saving therapeutic option in hematological malignancies. As previously established, most hematological malignancies are seen in the elderly population. Therefore, possible HLA-identical sibling donors of elderly patients are generally of an advanced age. In this study, we aimed to evaluate the effect of old age on stem cell mobilization and quality in older adult healthy sibling donors. MATERIALS AND METHODS Between 2006 and 2014, we evaluated 38 healthy donors aged ≥55 years. The granulocyte-colony stimulating factor (G-CSF) analogs were used at a dose of 5 µg/kg/day and administered subcutaneously twice a day for five days. CD34+ cells were estimated in the peripheral blood before collection of the apheresis product. The National Marrow Donor Program selects healthy unrelated donors if they are younger than 60 years. Therefore, we compared the product quality in donors over the age of 60 to that in donors aged 60 years or less. RESULTS We collected sufficient products from all the donors with one to three apheresis procedures. No serious complication was detected in all donors. Reaching the target CD34+ cell count in one day were detected in 83% of younger and 79% of older donors (P = NS). Collected CD34+ cells x10e6/recipient body weight (kg) was same and 5.1 in the groups (P = NS). There were no correlation between the donor age and these parameters. CONCLUSION Healthy donor apheresis in older adults can be performed effectively and possible donors should be evaluated regardless of their age. J. Clin. Apheresis 32:16-20, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Mehmet Ozen
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gunduz
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Pervin Topcuoglu
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Selami K Toprak
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Klara Dalva
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gunhan Gurman
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Osman Ilhan
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|