Large registries have shown that end-stage renal disease patients have longer survival after kidney transplantation (KT) than remaining on dialysis. However, the outcome for kidneys from donors ≥75 years and the survival of recipients of these organs compared to their dialysis counterparts with the same probability to obtain an organ, is unknown. We assessed outcomes of 5,974 deceased-donor recipients, 415 of whom received kidneys from donors ≥75 years. We aimed to pair each eligible case with one control that initiated dialysis before 2013 and that at some point were included in the waiting list for KT but were not transplanted during the whole study period. Controls had similar characteristics at the time of starting dialysis: age, sex, primary renal disease, cardiovascular comorbidities, history of malignant tumor or chronic liver disease. We found 371 pairs. Patients who received a kidney from an ≥75 year-old donor had a mean age of 68,7±5,8 years. Most of those kidneys (92.8%) were allocated to recipients ≥60 years-old. The whole cohort of 742 patients (371 KT and 371 dialysis controls) was followed-up for a maximum of 16 years, with a median of 2.9 years. During the whole observation period, there were 127 deaths (34.2%) among the KT group and 205 (55.2%) among the controls. Patient survival was higher for transplanted patients than those on dialysis remaining waitlisted at 1, 3, 5, and 10 years (90.7%, 83.6%, 72.5% and 49.3% vs. 87.9%, 65.6%, 48.5%, and 16.1%, respectively: adjusted proportional risk of death 2.18 [95%CI 1.72-2.76, p<0.001])[figure1]. Stratifying by age, hazard ratio for death in dialysis partners was 5.48 (95%CI 2.92-10.28) in patients <65y, 1.93 (1.24–3.00) in 65-69y, 1.61 (1.17–2.21) in those 70-74y and 1.39 (95%CI 0.40–1.16) in ≥75 year-olds. KT from donors ≥75 years-old is associated with an acceptable 66.5% 10-year death-censored graft survival. Overall, patients remaining on dialysis with a comparable chance of obtaining an organ, have a two-fold higher risk of death than those who receive an organ from a ≥75 donor. Moreover, this benefit is higher in recipients younger than 65, losing significance in elderly recipients ≥75.

CITATION INFORMATION: Pérez-Sáez M, Arcos E, Comas J, Crespo M, Lloveras J, Tort J, Pascual J, Catalan Renal Registry Committee Survival Benefit from Kidney Transplantation Using Kidneys from Deceased Donors Over 75 Years. Am J Transplant. 2016;16 (suppl 3).

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