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.
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Organ donation in the United States.in: Cecka J.M. Terasaki P.I. Clinical transplants 2003. UCLA Immunogenetics Center, Los Angeles2004: 65-76
- The OPTN/UNOS renal transplant registry 2003.in: Cecka J.M. Terasaki P.I. Clinical transplants 2003. UCLA Immunogenetics Center, Los Angeles2004: 1-12
- The OPTN waiting list, 1988-2002.in: Cecka J.M. Terasaki P.I. Clinical transplants 2003. UCLA Immunogenetics Center, Los Angeles2004: 53-64
- Expanded criteria donors for kidney transplantation.Am J Transplant. 2003; 3: 114-125
- Multivariate analysis of donor risk factors for graft survival in kidney transplantation.Transplantation. 2003; 75: 361-367
- Kidney transplantation in patients aged sixty years and older.Surgery. 1990; 108: 726-731
- How old is old for transplantation?.Am J Transplant. 2004; 4: 2067-2074
- Matching older kidneys with older patients does not improve allograft survival.J Am Soc Nephrol. 2002; 73: 70-76
- Kidney transplantation in the elderly: age-matching as compared to HLA-matching: a single center experience.Transplantation. 2002; 73: 1356-1359
- Effect of donor recipient age match on survival after first deceased donor renal transplantation.J Am Soc Nephrol. 2004; 15: 1086-1091
- Evidence that the ratio of donor kidney weight to recipient body weight, donor age, and episodes of acute rejection correlate independently with live-donor graft function.Transplantation. 2002; 74: 280-283
- Interaction between donor and recipient age in determining the risk of chronic allograft failure.J Am Geriatr Soc. 2002; 50: 14-17
- Performance of different prediction equations for estimating renal function in kidney transplantation.Am J Transplant. 2004; 4: 1826-1835
- Increased kidney transplantation utilizing expanded criteria deceased organ donors with results comparable to standard criteria donor transplant.Ann Surg. 2004; 239: 688-697
- Dual-kidney transplantation with organs from expanded criteria donors.Transplantation. 2004; 78: 692-696
- The presence of glomerular sclerosis at time zero has a significant impact on function after cadaveric renal transplantation.Transplantation. 2003; 75: 344-346
- The hazards of basing acceptance of cadaveric renal allografts on pulsatile perfusion parameters alone.Transplantation. 2003; 75: 2029-2033
- Kidney and pancreas transplantation at Wake Forest University Baptist Medical Center.in: Cecka J.M. Terasaki P.I. Clinical transplants 2003. UCLA Immunogenetics Center, Los Angeles2004: 229-245
- The Banff 97 working classification of renal allograft pathology.Kidney Int. 1999; 55: 713-723
- Excerpts from the United States renal data system 2004 annual data report.Am J Kidney Dis. 2005; 45: S16-S28
- How great is the survival advantage of transplantation over dialysis in elderly patients?.Nephrol Dial Transplant. 2004; 19: 945-991
- Patient and graft survival in older kidney transplant recipients.J Am Soc Nephrol. 2004; 15: 1052-1060
- Kidney transplantation in the elderly.J Am Soc Nephrol. 2003; 14: 187-196
- Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates.J Am Soc Nephrol. 2001; 12: 589-597
- Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.N Engl J Med. 1999; 341: 1725-1730
- Donor age and improvement in graft survival over time.Am J Transplant. 2004; 4 ([abstract]): 602
- State of renal transplantation in older Americans.Am J Transplant. 2004; 4 ([abstract]): 517
- Predicting clinical outcome in the elderly renal transplant recipient.Kidney Int. 2000; 57: 2144-2150
- Renal transplantation in the elderly.Curr Opin Urol. 2001; 11: 159-163
- Initial experience with the expanded criteria donor kidney allocation system.Am J Transplant. 2004; 4 ([abstract]): 160
- Initial experience with the expanded criteria donor kidney allocation system.Am J Transplant. 2004; 4 ([abstract]): 303
- The expanded criteria donor dilemma in cadaveric renal transplantation.Transplantation. 2003; 75: 1940-1945
- Will you still list me when I’m 64?.J Am Geriatr Soc. 2002; 50: 195-197
- Age and immune response in organ transplantation.Transplantation. 2005; 79: 127-132
- Increased immunosuppressive vulnerability in elderly renal transplant recipients.Transplantation. 2000; 69: 885-889
- Age-matching in renal transplantation.Nephrol Dial Transplant. 2000; 15: 696-700
- WCN 2003 satellite symposium on kidney transplantation in the elderly.Nephrol Dial Transplant. 2004; 19: 43-46
- Evaluation of the Eurotransplant senior program.Am J Transplant. 2002; 2: 664-670
Accepted: September 22, 2005
Received in revised form: September 20, 2005
Received: February 18, 2005
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.