Poor Renal Function and Increased Mortality in Elderly Recipients of Deceased Donor Kidneys from Elderly Donors

S. Berger,¹ H. Peters-Sengers,² M. Heemskerk,³ F. Bemelman,² J. Homan van der Heide.²

¹Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
²Department of Nephrology, Academic Medical Center, Amsterdam, Netherlands
³Dutch Transplant Foundation, Leiden, Netherlands.

Meeting: 2015 American Transplant Congress

Abstract number: A141

Keywords: Donors, Graft acceptance, Graft survival, marginal, Outcome

Session Information

Session Name: Poster Session A: Kidney Candidate Issues and Outcomes

Session Type: Poster Session

Date: Saturday, May 2, 2015

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

Background: Within the Eurotransplant Senior Program kidneys form donors older than 65 both after cardiac death (DCD) or brain death (DBD) are allocated to recipients older than 65. The results of this approach have not been thoroughly evaluated. We compared outcomes of elderly recipients of elderly DCD and DBD kidneys within the Eurotransplant Senior Program (ESP) to the outcome of elderly recipients of kidneys from young donors.

Methods: In this retrospective cohort study we included all recipients (at least 18 years old) from all Dutch centers transplanted from 2002 to 2012 with a first DBD or DCD kidney (Maastricht category III). We categorized young and elderly recipients either transplanted with young or elderly donors, and classified them by donor type. Data were retrieved from the Dutch Organ transplantation Registry (NOTR).

Findings: The use of DCD kidneys from elderly donors resulted in a significantly increased incidence of delayed graft function and acute rejections within 3 months after transplantation as well as a higher 5-year crude graft loss (HR 1.75 CI 1.11-2.75) compared with elderly patients transplanted with young DBD kidneys. The mortality risk within 5 years was significantly higher for elderly recipients with DCD (n=245, HR 2.27 CI(1.34-3.84) or DBD kidneys (n=137, HR 1.71 CI(1.06-2.77)) from elderly donors as compared with elderly recipients transplanted with DBD (n=144) kidneys from donors under 65 years. One year after transplantation 63.8% of elderly DCD kidneys had an eGFR below 30 ml/min/1.73m² compared with 45.5% in recipients of elderly DBD kidneys, and 26.0% in elderly recipients with young donors (P< 0.05).

Interpretation: Acceptance of elderly DCD or DBD donors for elderly recipients is associated with increased risk of mortality compared with elderly patients transplanted with young DBD kidneys. Renal function of elderly recipients transplanted with elderly DCD kidneys at one year was markedly inferior as compared to all other categories. The current practice of transplanting vulnerable kidneys to vulnerable recipients may need reconsideration.

To cite this abstract in AMA style:

Berger S, Peters-Sengers H, Heemskerk M, Bemelman F. Poor Renal Function and Increased Mortality in Elderly Recipients of Deceased Donor Kidneys from Elderly Donors [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/poor-renal-function-and-increased-mortality-in-elderly-recipients-of-deceased-donor-kidneys-from-elderly-donors/. Accessed November 21, 2024.

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