Merion et al. (JAMA, 2005) concluded that ECD renal grafts benefit a recipient if they are older than 40 with hypertension or diabetes, and have an expected wait time over 1350 days. Our center has used a many ECD organs in patients (pts) 60 and over despite a short time to SCD transplant (tx). Is this beneficial to our patients?

Pts listed for renal transplantation age 60 or older at our center from 1/1997 to 12/2009 were evaluated if they remained or died on the wait list (WL), or received a ECD or SCD allograft. Observation ended 12/29/12. The 419 pts on the WL were removed for: transplanted with SCD(32%) or ECD graft(15%), medically unsuitable(17%), and expired(15%).

-Pt Surv ECD vs SCD vs WL from time of listing: log rank p <0.0001; ECD v SCD p=0.04; ECD v WL and SCD v WL p<0.0001

-Pt Surv ECD vs SCD/WL from time of listing: log rank p = 0.12 ns

-Graft Surv ECD vs SCD from time of transplant: log rank p = 0.11 ns

With short times to transplant for recipients age 60 or over, there was no difference in receiving an ECD graft slightly earlier than staying on the WL for an SCD transplant (SCD/WL). SCD graft recipients had improved survival over ECD graft recipients, and both groups did better than without transplant.

With short waiting time, waiting for an SCD transplant did not result in lower patient survival, and did result in better graft survival in patients who were 60 or older at the time of listing. Our unadjusted 5 yr ECD pt survival data (0.65 from listing and 0.58 from tx) is comparable to SRTR Annual Report (age at tx >65: 55.3%, age at tx 50-64: 61.5%). With time to transplant increasing over the last several years, it will be interesting to see what minimal waiting time difference between ECD and SCD organs result in a survival advantage for this older patient population.

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