Background
The aging donor and recipient population have led to new challenges in kidney transplantation.
The purpose of this study was to review retrospectively our single center experience
in deceased-donor kidney transplantation, with respect to donor and recipient age.
Methods
From October 1, 2001, through February 20, 2004, we performed 144 deceased-donor kidney
transplantations, which included 37 procedures (26%) in recipients ≥60 years old and
107 procedures (74%) in recipients 19 to 59 years old. The deceased-donor pool included
57 expanded criteria donors (ECD) and 87 standard criteria donors (defined as not
ECD). ECD kidneys were used by matching estimated renal functional mass to recipient
size (body mass index, <25 kg/m2), which included the use of dual kidney transplantations (n = 9). ECD kidney recipients
were further selected on the basis of age >40 years and low immunologic risk. Recipients
received rabbit antithymocyte globulin or alemtuzumab induction in combination with
tacrolimus, mycophenolate mofetil, and steroids.
Results
The mean age differed between recipient groups (65 vs 46 years; P < .001). In recipients
≥60 years old, 23 recipients (62%) received kidney transplants from ECDs compared
with 34 kidney transplants from ECDs (32%; P < .001) in recipients who were <60 years
old. Patient survival was 89% in recipients who were ≥60 years old, compared with
95% in recipients who were <60 years old (P = .11), with a mean follow-up time of
27 months. Kidney graft survival rates were 84% in both recipient groups. Initial
and subsequent graft function, rejection, infection, reoperation, length of stay,
readmission, and resource use were similar among groups.
Conclusion
By the matching of nephron mass with recipient size and avoiding the use of ECD kidneys
in recipients with a high immunologic risk, short-term outcomes that are comparable
with standard criteria donor kidneys in younger patients can be achieved with either
older donors or recipients, regardless of age.
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Article info
Publication history
Accepted:
September 22,
2005
Received in revised form:
September 20,
2005
Received:
February 18,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
