Old DCD Kidneys to Old Recipients Have a Good Outcome; Is That the Solution for the Old Patients on the Waiting List?
Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom
Meeting: 2013 American Transplant Congress
Abstract number: C1279
The proportion of DCD donors among deceased transplants in UK has increased from 8% to 40 % with a striking increase in the mean age of DCD by 10 years to 53 years. Older recipients over the age of 65 years represent more than 25% of the total transplant waiting list in our centre. On the basis of that we expanded significantly the acceptance criteria for DCD kidney donors so they now represent 60% of our cadaveric program and 40% of our overall program. Older recipients might be well cared for with kidneys with less longevity but sufficient early function.
Aim: To investigate the results of transplanting older donor (>60 years old) DCD kidneys to older (>60 years old) recipients to see if it is an appropriate use of these extra resource of organs. Also see what the impact of those marginal kidneys is on the older recipient mortality.
Results: Over a period of 30 months 145 renal transplants from DCD donors were performed, 94 of them from donors over 60 (67%) and 62 of those kidneys (43% of the total) were transplanted to recipients over 60 years. Median age of those donors was 69 (range 61-80) years (with 47 of those donors over 65), whereas the median recipient age was 68 (range 60-80) years. Median follow up was 14 months. Delayed graft function (defined as need for dialysis in the first week) was seen in 44 patients (71%) and it lasted a mean of 7.5 and a median of 3 days. Median length of stay was 13 days. There was 1 case of PNF (1.5%), 4 cases of graft failure, (at 1mo, 3 mo, 6 mo, 1 year) and 3 deaths (2 in the 1st year) giving a 1-year mortality of 3.2% and an uncensored 1-year graft survival of 89%.
The Median MDRD GFR (SD) at 1, 3, 6 and 12 months was 34 (15.7), 38 (13.3), 37 (12.3), and 37 (9) ml/min/1.73m2.
This compares with the 1 year MDRD GFR in all DCD recipients (irrespective of donor or recipient age) of 46 ml/min/1.73m2.
Conclusion:Older DCD donors represent an excellent source of transplanted kidneys. They have a low PNF, a low rejection rate and a good (at least) short-term graft survival when transplanted to older recipients. It also gives them a survival far outweighing that on dialysis. The 1-year kidney function of those kidneys to old recipients is as good as the 1-year results of all DCD kidneys irrespective of donor and recipient age. Our preliminary results support the use of those ‘marginal’ kidneys to this recipient group.
To cite this abstract in AMA style:
Jameel M, Qasim M, Szabo L, Stephens M, Asderakis A. Old DCD Kidneys to Old Recipients Have a Good Outcome; Is That the Solution for the Old Patients on the Waiting List? [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/old-dcd-kidneys-to-old-recipients-have-a-good-outcome-is-that-the-solution-for-the-old-patients-on-the-waiting-list/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress