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1
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Lindahl JP, Åsberg A, Heldal K, Jenssen T, Dörje C, Skauby M, Midtvedt K. Long-term Outcomes After Kidney Transplantation From DBD Donors Aged 70 y and Older. Transplant Direct 2024; 10:e1660. [PMID: 38911276 PMCID: PMC11191925 DOI: 10.1097/txd.0000000000001660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/10/2024] [Indexed: 06/25/2024] Open
Abstract
Background Transplantation of kidneys from elderly donations after brain death (DBD) donors has increased owing to organ shortages. We aimed to assess the impact on long-term kidney transplant outcomes from DBD donors aged 70 y and older compared with kidneys from younger donors. Methods From 2007 to 2022, 2274 first single kidney transplantations from DBD donors were performed at our center. Data from 1417 kidney transplant recipients receiving a DBD organ were included and categorized into 3 groups according to donor age: 70 y and older (n = 444, median age 74 y), 60-69 y (n = 527, median age 64 y), and a reference group consisting of donors aged 45-54 y (n = 446, median age 50 y). Kaplan-Meier plots and multivariate Cox regression with correction for recipient, donor, and transplant characteristics were used to investigate patient and kidney graft survival outcomes. Results The median patient follow-up time was 9.3 y (interquartile range, 5.3-13.1). The adjusted hazard ratios for patient death in recipients of kidneys from DBD donors aged 70 y and older compared with 60-69 y and 45-54 y were 1.12 (95% confidence interval [CI], 0.92-1.36; P = 0.26) and 1.62 (95% CI, 1.26-2.07; P < 0.001), respectively. Compared with recipients of donors aged 60-69 y and 45-54 y, the adjusted hazard ratios for kidney graft loss in recipients of donors aged 70 y and older were 1.23 (95% CI, 1.02-1.48; P = 0.029) and 1.94 (95% CI, 1.54-2.45; P < 0.001), respectively. Conclusions Transplantation of kidneys from DBD donors aged 70 y and older resulted in acceptable long-term outcomes and is encouraging.
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Affiliation(s)
- Jørn Petter Lindahl
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anders Åsberg
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Kristian Heldal
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trond Jenssen
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christina Dörje
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Morten Skauby
- Department of Transplant Medicine, Section of Transplant Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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2
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Kidney transplantation from elderly donors (> 70 years): a systematic review. World J Urol 2023; 41:695-707. [PMID: 36907943 DOI: 10.1007/s00345-023-04311-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/22/2023] [Indexed: 03/14/2023] Open
Abstract
PURPOSE The incidence of kidney transplants from elderly donors over 70 years of age has increased significantly over the past 10 years to reach 20% of available kidney graft in some European countries. However, there is little data available on the outcomes of transplants from these donors. We performed a systematic review to evaluate the outcomes of transplantation from donors over 70 years of age. METHODS A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting outcomes on kidney transplants from donors over 70 years. Due to the heterogeneity of the studies, a meta-analysis could not be performed. RESULTS A total of 29,765 patients in 27 studies were included. The mean donors age was 74.79 years, and proportion of kidney graft from women was 53.54%. The estimated 1- and 5-year kidney death-censored graft survivals from donors > 70 years old were, respectively, 85.95 and 80.27%, and the patient survivals were 90.88 and 71.29%. The occurrence of delayed graft function was 41.75%, and primary non-function was 4.67%. Estimated graft function at 1 and 5 years was 36 and 38 mL/min/1.73 m2. Paucity data were available on post-operative complications. CONCLUSIONS Elderly donors appear to be a reliable source of grafts. However, these transplants are associated with a high rate of delayed graft function without repercussion on long-term graft survival. Allocation strategy to elderly recipients is the main factor of decreased recipient survival.
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3
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Villanego F, Vigara LA, Cazorla JM, Naranjo J, Atienza L, Garcia AM, Montero ME, Minguez MC, Garcia T, Mazuecos A. Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy. Transpl Int 2022; 35:10056. [PMID: 35734238 PMCID: PMC9207180 DOI: 10.3389/ti.2022.10056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022]
Abstract
The increasing comorbidity of kidney transplant (KT) donors make it necessary to develop scores to correctly assess the quality of kidney grafts. This study analyzes the usefulness of the preimplantation biopsy and the Kidney Donor Profile Index (KDPI) as indicators of KT survival from expanded criteria donors (ECD). Retrospective study of KT in our center between January 2010 to June 2019 who received a kidney from an ECD and underwent a preimplantation biopsy. 266 KT were included. Graft survival was categorized by KDPI quartiles: Q1 = 86%, Q2 = 95%, Q3 = 99% and Q4 = 100%. KT from KDPI Q1 presented better survival (p = 0.003) and Q4 donors had worse renal function (p = 0.018) and poorer glomerular filtration rate (3rd month; p = 0.017, 1st year; p = 0.010). KT survival was analyzed according to KDPI quartile and preimplantation biopsy score simultaneously: Q1 donors with biopsy score ≤3 had the best survival, especially comparing against Q3 with a biopsy score >3 and Q4 donors (p = 0.014). In multivariable analysis, hyaline arteriopathy, glomerulosclerosis, and KDPI Q4 were predictors for graft survival. High KDPI and a greater histological injury in the preimplantation biopsy, especially glomerular and vascular lesions, were related to a higher rate of KT loss from ECD.
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Affiliation(s)
- F. Villanego
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - L. A. Vigara
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - J. M. Cazorla
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - J. Naranjo
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - L. Atienza
- Department of Pathology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - A. M. Garcia
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - M. E. Montero
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - M. C. Minguez
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - T. Garcia
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - A. Mazuecos
- Department of Nephrology, Hospital Universitario Puerta del Mar, Cadiz, Spain
- *Correspondence: A. Mazuecos,
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4
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Liu L, Cheng K, Huang J. Effect of Long Cold Ischemia Time of Kidneys from Aged Donors on Prognosis of Kidney Transplantation. Ann Transplant 2021; 26:e928735. [PMID: 34663778 PMCID: PMC8540027 DOI: 10.12659/aot.928735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
With the increasing incidence of end-stage renal disease (ESRD), patients' life span and life quality are significantly reduced. Kidney transplantation has gradually become the ideal method for treating ESRD, and the shortage of organ sources has become the main problem. In recent years, China has successfully realized the transformation of organ sources. Voluntary donation after the death of citizens has increased year by year, and the number of kidney transplantations has increased, which alleviates the organ shortage to a certain extent, but compared with the past, the increasing proportion of aged donors has also become an inevitable global problem. At the same time, due to the sudden and widespread distribution of voluntary donation, most donor kidneys have the problem of longer cold ischemic time (CIT). The probability of adverse events, such as delayed renal function recovery after transplantation, was also significantly increased. At present, there is little research on the effect of donor's aging and long CIT on the prognosis of renal transplantation. This paper reviews the literature in recent years and explore this problem from 2 aspects: the elderly donor and the long CIT.
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Affiliation(s)
- Lian Liu
- Center for Organ Transplantation, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China (mainland)
| | - Ke Cheng
- Center for Organ Transplantation, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Jufang Huang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China (mainland)
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5
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Jamshidian Tehrani N, Amirghofran Z, Shamsaeefar AR, Karachi A, Karimi MH. Fc Receptor-Like Gene Expression in Renal Transplantation Patients. Galen Med J 2021; 9:e1730. [PMID: 34466580 PMCID: PMC8343822 DOI: 10.31661/gmj.v9i0.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/18/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background:
It has been well-documented that the Fc receptor-like (FCRL) molecule contributes to the pathogenesis of certain autoimmune disorders. FCRL molecules belong to the immunoglobulin superfamily produced by B cells. Also, these molecules induce activating or inhibitory signals of B cells. According to this information and also considering the critical role of immune reactions in organ transplantation, the following experiment was performed to analyze the gene expression level of FCRLs in peripheral blood mononuclear cells of kidney transplant recipients.
Materials and Methods:
Blood samples were obtained from 32 renal transplant patients on days 1, 3, and 7 post-transplantations. Patients were divided into two groups according to the presence or absence of rejection. Also, 24 age-matched healthy subjects were enrolled as control group. After total RNA extraction from peripheral blood mononuclear cells (PBMC) and cDNA synthesis, the gene expression levels of FCRL1, FCRL2, and FCRL4 in each group were measured by real-time polymerase chain reaction.
Results:
Our results showed that FCRL1 expression levels in kidney transplant patients were significantly less than healthy controls. The overall FCRL2 expression level was not significantly different between them. However, at days 1 and 7, following transplantation in the non-rejected group FCRL2 level was significantly higher than the control group. Comparing the FCRL4 gene expression levels of both groups with healthy controls showed a significant decrease in the third and seventh days post-transplantation.
Conclusion: It can be concluded that mononuclear cells, mainly B cells, have an essential role to play in kidney transplantation.
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Affiliation(s)
| | | | - Ali Reza Shamsaeefar
- Organ Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Aida Karachi
- Organ Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Mohammad Hossein Karimi
- Organ Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Correspondence to: Mohammad Hossein Karimi, Organ Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran Telephone Number: 09173149022 Email Address:
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Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors. Sci Rep 2021; 11:12226. [PMID: 34108573 PMCID: PMC8190122 DOI: 10.1038/s41598-021-91843-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
As the use of elderly kidney donors for transplantation is increasing with time, there is a need to understand which factors impact on their prognosis. No data exist on the impact of an impaired renal function (IRF) in such population. 116 kidney recipients from deceased kidney donors over 70 years were included from 2005 to 2015 in a single-center retrospective study. IRF before organ procurement was defined as a serum creatinine above 1.0 mg/dl or a transient episode of oligo-anuria. Mean ages for donors and recipients were respectively 74.8 ± 3.5 and 66.7 ± 8.0. Graft survival censored for death at 5 years was of 77%. Using a multivariate analysis by Cox model, the only predictor of graft loss present in the donor was IRF before organ procurement (HR 4.2 CI95[1.8–9.7]). IRF was also associated with significant lower estimated glomerular filtration rates up to 1 year post-transplantation. By contrast, KDPI score (median of 98 [96–100]), was not associated with the risk of graft failure. Then, IRF before kidney procurement may define a risk subgroup among very-old deceased kidney donors, in whom pre-implantatory biopsies, dual kidney transplantation or calcineurin inhibitor-free immunosuppressive regimen could help to improve outcomes.
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Schachtner T, Otto NM, Reinke P. Two decades of the Eurotransplant Senior Program: the gender gap in mortality impacts patient survival after kidney transplantation. Clin Kidney J 2020; 13:1091-1100. [PMID: 33391754 PMCID: PMC7769544 DOI: 10.1093/ckj/sfz118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Long-term outcomes of the Eurotransplant Senior Program (ESP) are urgently needed to improve selection criteria and allocation policies in the elderly. METHODS We analysed patient and allograft outcomes of 244 ESP-kidney transplant recipients (KTRs) between 1999 and 2019 and assessed quality of living compared with 82 ESP-waitlisted dialysis patients using standardized short form-8. RESULTS We observed 1-, 5- and 10-year patient survival of 91.7, 66.3 and 38.0%, respectively. Mortality risk factors included male gender (P = 0.006) and T-cell-mediated rejection (P < 0.001). Median patient survival of male ESP-KTRs was 80 versus 131 months for female ESP-KTRs (P = 0.006). 1-, 5- and 10-year death-censored allograft survival was 93.3, 82.6 and 70.4%. Risk factors included high body mass index (P < 0.001) and T-cell-mediated rejection (P < 0.001). After re-initiation of dialysis median patient survival was 58 months. Change of estimated glomerular filtration rate showed a mean decline of 2.3 and 6.8 mL/min at 5 and 10 years. Median physical and mental component scores of ESP-KTRs were 40.2 and 48.3, significantly higher compared with dialysis patients (P < 0.05). Of ESP-KTRs, 97.5% who underwent transplantation would again do so. CONCLUSIONS Long-term outcomes of ESP-KTRs ultimately support the effectiveness of an age-matched allocation system. Our data suggest that the survival advantage of women is maintained after kidney transplantation and calls for gender-specific care.
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Affiliation(s)
- Thomas Schachtner
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin-Brandenburg Center of Regenerative Therapies, Berlin, Germany
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Natalie M Otto
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin-Brandenburg Center of Regenerative Therapies, Berlin, Germany
| | - Petra Reinke
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany
- Berlin-Brandenburg Center of Regenerative Therapies, Berlin, Germany
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8
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[Very-old deceased donors in kidney transplantation: How far can we go?]. Nephrol Ther 2020; 16:408-413. [PMID: 33203614 DOI: 10.1016/j.nephro.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022]
Abstract
In order to increase the pool of organ donors, kidney transplantation from very old-donors, notably aged more than 70, is increasing. Compared to the United States, where the use of these grafts does not reach 5%, in France it reaches over 20%. Kidney aging is determined by a progressive glomerusclerosis, interstitial fibrosis, and nephrosclerosis, responsible of a linear decrease of glomerular filtration rate with time. Aging in kidney transplantation goes along also with an increased immunogenicity and risk of ischemia-reperfusion injuries. Hence, the prognosis of these transplantations is worse than those from younger donors, even though it remains better than dialysis. Data is lacking on risk factors of graft loss in this specific population. Hypothermic perfusion machine, pre-implantation kidney biopsy, dual kidney transplantation and immunosuppressive strategies have been evaluated to improve the long-term prognosis of these grafts.
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9
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Quast LS, Grzella S, Lengenfeld T, Pillokeit N, Hummels M, Zgoura P, Westhoff TH, Viebahn R, Schenker P. Outcome of Kidney Transplantation Using Organs From Brain-dead Donors Older Than 75 Years. Transplant Proc 2019; 52:119-126. [PMID: 31901319 DOI: 10.1016/j.transproceed.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/23/2019] [Accepted: 11/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated whether older donor kidneys aged >75 years have acceptable long-term function and if recipients can benefit sufficiently from the transplantation. METHODS This single-center study retrospectively analyzed patient data from 217 deceased donor kidney transplants performed between 1998 and 2014 as part of the Eurotransplant Senior Program, where the organ donors were ≥65 years old. Depending on donor age, the groups "older donors" (OD; n = 161) and "very old donors" (VOD; n = 56) received transplants from donors aged 65 to 75 years and >75 years, respectively. Donor and recipient clinical characteristics, delayed graft function, estimated glomerular filtration rate, 1-year rejection rate, patient and graft survival, and postoperative complications were investigated. RESULTS Comparing VOD group vs OD group, the 1-year, 3-year, and 5-year graft survival rates were 80.4% vs 76.4%, 62.5% vs 65.8%, and 42.6% vs 57.3%, respectively. Patient survival rates after 1, 3, and 5 years were 89.3% vs 88.2%, 71.4% vs 78.2%, and 57.5% vs 71.8%, respectively. There were no significant differences between the 2 groups (graft survival P = .107; patient survival P = .126). Kidney graft function after 1, 2, and 3 years was significantly better in the OD group than in the VOD group. No differences were found regarding postoperative complications, rejection rate, and delayed graft function. CONCLUSION The utilization of selected kidney-grafts from donors >75 years resulted in acceptable outcomes after kidney transplantation and could expand the donor pool. In contrast to the high mortality rate during dialysis, recipients in both groups benefited from transplantation.
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Affiliation(s)
- Louisa Sarah Quast
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Sascha Grzella
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Lengenfeld
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Nina Pillokeit
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Marielle Hummels
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Panagiota Zgoura
- Medical Department I, University Hospital Marienhospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Timm H Westhoff
- Medical Department I, University Hospital Marienhospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Richard Viebahn
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany.
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10
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Heldal K, Midtvedt K, Lønning K, Iversen T, Hernæs KH, Tsarpali V, Reisæter AV, Bernklev T. Kidney transplantation: an attractive and cost-effective alternative for older patients? A cost-utility study. Clin Kidney J 2019; 12:888-894. [PMID: 31807304 PMCID: PMC6885668 DOI: 10.1093/ckj/sfz018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background In the elderly, kidney transplantation is associated with increased survival and improved health-related quality of life compared with dialysis treatment. We aimed to study the short-term health economic effects of transplantation in a population of elderly kidney transplant candidates. Methods Self-perceived health, quality-adjusted life years (QALYs) and costs were evaluated and compared 1 year before and 1 year after kidney transplantation in patients included in a single-centre prospective study of 289 transplant candidates ≥65 years of age. Results Self-perceived health and QALYs both significantly improved after transplantation. At 1 year, the costs per QALY were substantially higher for transplantation (€88 100 versus €76 495), but preliminary analyses suggest a favourable long-term health economic effect. Conclusions Kidney transplantation in older kidney transplant recipients is associated with improved health but also with increased costs the first year after engraftment when compared with remaining on the waiting list. Any long-term cost-effectiveness needs to be confirmed in studies with longer observation times.
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Affiliation(s)
- Kristian Heldal
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Kjersti Lønning
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Tor Iversen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | | | - Vasiliki Tsarpali
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Tomm Bernklev
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Vestfold Hospital Trust, Tonsberg, Norway
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11
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Colussi G, Casati C, Colombo VG, Camozzi MLP, Salerno FR. Renal transplants from older deceased donors: Is pre-implantation biopsy useful? A monocentric observational clinical study. World J Transplant 2018; 8:110-121. [PMID: 30148077 PMCID: PMC6107519 DOI: 10.5500/wjt.v8.i4.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/09/2018] [Accepted: 05/13/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To compare survival of kidney transplants from deceased extended criteria donors (ECD) according to: (1) donor graft histological score; and (2) allocation of high score grafts either to single (SKT) or dual (DKT) transplant.
METHODS Renal biopsy was performed as part of either a newly adopted DKT protocol, or of surveillance protocol in the past. A total 185 ECD graft recipients were categorized according to pre-implantation graft biopsy into 3 groups: SKT with graft score 1 to 4 [SKT(1-4), n = 102]; SKT with donor graft score 5 to 8 [SKT(> 4), n = 30]; DKT with donor graft score 5 to 7 (DKT, n = 53). Graft and patient survival were analyzed by Kaplan-Meier curves and compared by log-rank test. Mean number of functioning graft years by transplant reference, and mean number of dialysis-free life years by donor reference in recipients were also calculated at 1, 3 and 6 years from transplantation.
RESULTS There were no statistically significant differences in graft and patient survival between SKT(1-4) and SKT(> 4), and between SKT(> 4) and DKT. Recipient renal function (plasma creatinine and creatinine clearance) at 1 years did not differ in SKT(1-4) and SKT(> 4) (plasma creatinine 1.71 ± 0.69 and 1.69 ± 0.63 mg/dL; creatinine clearance 49.6 + 18.5 and 52.6 + 18.8 mL/min, respectively); DKT showed statistically lower plasma creatinine (1.46 ± 0.57, P < 0.04) but not different creatinine clearance (55.4 + 20.4). Due to older donor age in the DKT group, comparisons were repeated in transplants from donors older than 70 years, and equal graft and patient survival in SKT and DKT were confirmed. Total mean number of functioning graft years by transplant reference at 1, 3 and 6 post-transplant years were equal between the groups, but mean number of dialysis-free life years by donor reference were significantly higher in SKT (mean difference compared to DKT at 6 years: 292 [IQR 260-318] years/100 donors in SKT(1-4) and 292.5 [(IQR 247.8-331.6) in SKT(> 4)].
CONCLUSION In transplants from clinically suitable ECD donors, graft survival was similar irrespective of pre-implantation biopsy score and of allocation to SKT or DKT. These results suggest use of caution in the use of histology as the only decision criteria for ECD organ allocation.
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Affiliation(s)
- Giacomo Colussi
- Fabio Rosario Salereno, Division of Nephrology, Dialysis and Renal Transplantatation, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy
| | - Costanza Casati
- Fabio Rosario Salereno, Division of Nephrology, Dialysis and Renal Transplantatation, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy
| | - Valeriana Giuseppina Colombo
- Fabio Rosario Salereno, Division of Nephrology, Dialysis and Renal Transplantatation, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy
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12
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Incollingo P, Peluso G, Pelosio L, Jamshidi AA, Montanaro V, Dodaro C, Vernillo A, Minieri G, Esposito A, Atontsa F, Capezzuoli L, Apostolico G, Menkulazi M, Paternoster M, Calogero A, Santangelo ML. Ethical Issues in the Use of Suboptimal Kidneys for Transplants: An Italian Point of View. Transplant Proc 2018; 51:106-110. [PMID: 30655131 DOI: 10.1016/j.transproceed.2018.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/08/2018] [Accepted: 05/21/2018] [Indexed: 11/15/2022]
Abstract
The shortage of organs leads to the need for utilizing suboptimal kidneys for transplantation. The distinction between optimal, marginal, and suboptimal kidneys leads surgeons to face not only technical problems but also ethical and legal issues related to clinical advantages offered by the transplant of a nonstandard kidney and the acquisition of consent. Between 1999 and 2015, we performed 658 transplants, 49 (7.5%) using suboptimal kidneys. All patients were alive and with vital graft throughout follow-up. We did not encounter any major surgical complications. From a technical point of view, our experience and literature review confirm that transplant of suboptimal kidney leads to good clinical results but exposes patients to a increased risks of surgical complications. Therefore, these interventions must take place in hospitals fully prepared for this type of surgery and performed by experienced transplant surgeons with proper matching between organ and recipient. Considering the insufficient resources available, from an ethical and legal point of view, doctors play an essential role in optimizing the use of these kidneys by avoiding wastage of organs, ensuring that transplants are done in suitable patients, and that patients are fully informed and aware of the risks and benefits associated with the specific suboptimal kidney being transplanted. We believe that, in highly specialized centers, the number of suboptimal kidney transplants should be increased, as their use has shown good clinical results and carries fewer ethical issues compared with marginal kidneys. Further, suboptimal kidneys may also be proposed for use in young patients with end-stage renal disease.
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Affiliation(s)
- P Incollingo
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy.
| | - G Peluso
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - L Pelosio
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - A A Jamshidi
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - V Montanaro
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - C Dodaro
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - A Vernillo
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - G Minieri
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - A Esposito
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - F Atontsa
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - L Capezzuoli
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - G Apostolico
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - M Menkulazi
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - M Paternoster
- Operative Unit of Forensic and Bioethical Medicine, University Federico II of Naples, Naples, Italy
| | - A Calogero
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - M L Santangelo
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
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13
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Casati C, Colombo VG, Perrino M, Rossetti OM, Querques M, Giacomoni A, Binaggia A, Colussi G. Renal Transplants from Older Deceased Donors: Use of Preimplantation Biopsy and Differential Allocation to Dual or Single Kidney Transplant according to Histological Score Has No Advantages over Allocation to Single Kidney Transplant by Simple Clinical Indication. J Transplant 2018; 2018:4141756. [PMID: 29862061 PMCID: PMC5976897 DOI: 10.1155/2018/4141756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Grafts from elderly donors (ECD) are increasingly allocated to single (SKT) or dual (DKT) kidney transplantation according to biopsy score. Indications and benefits of either procedure lack universal agreement. METHODS A total of 302 ECD-transplants in period from Jan 1, 2000, to Dec 31, 2015, were allocated to SKT (SKTpre) on clinical grounds alone (before Dec 2010, pre-DKT era, n = 170) or according to a clinical-histological protocol (after Dec 2010, DKT era, n = 132) to DKT (n = 48), SKT biopsy-based protocol ("high-risk", SKThr, n = 51), or SKT clinically based protocol ("low-risk", SKTlr, n = 33). Graft and patient survival were compared between the two periods and between different transplant categories. RESULTS Graft and overall survival in recipients from ECD in pre-DKT and DKT era did not differ (5-year graft survival 87.7% and 84.2%, resp.); equal survival in the 2 ECD periods was shown in both donor age ranges of 60-69 and >70-years, and in low-risk or high-risk ECD categories. Within the DKT protocol SKThr showed worst graft and overall survival in the 60-69 donor age range; DKT did not result in significantly better outcome than SKT from ECD in either era. One-year posttransplant creatinine clearance in recipients did not differ between any ECD transplant category. At 3 and 5 years after transplantation there were significantly higher total dialysis-free recipient life years from an equal donor number in the pre-DKT era than in the DKT protocol. CONCLUSIONS Use of a biopsy-based protocol to allocate grafts from aged donors to SKT or DKT did not result in better short term graft survival than a clinically based protocol with allocation only to SKT and reduced overall recipient dialysis-free life years in time.
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Affiliation(s)
- Costanza Casati
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeriana Giuseppina Colombo
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marialuisa Perrino
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Marialuisa Querques
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Giacomoni
- Division of Transplant Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Agnese Binaggia
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giacomo Colussi
- Division of Nephrology, Dialysis and Kidney Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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14
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Lønning K, Heldal K, Bernklev T, Brunborg C, Andersen MH, von der Lippe N, Reisæter AV, Line PD, Hartmann A, Midtvedt K. Improved Health-Related Quality of Life in Older Kidney Recipients 1 Year After Transplantation. Transplant Direct 2018; 4:e351. [PMID: 29707622 PMCID: PMC5908461 DOI: 10.1097/txd.0000000000000770] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We aimed to evaluate changes in health-related quality of life (HRQoL) in patients 65 years or older from time of kidney transplantation (KTx) until 1 year postengraftment. METHODS A single-center prospective study was conducted. HRQoL was measured pre-KTx and at 2, 6, and 12 months postengraftment using self-reported Kidney Disease and Quality of Life short-form version 1.3. Intraindividual scores before and after KTx were evaluated. Liu Comorbidity Index was registered at enlisting. short-form-36 scores were additionally compared with scores from an age-matched population. RESULTS From January 1, 2013, until November 30, 2016, a total of 289 waitlisted patients were included. By September 1, 2017, 134 had reached 1 year postengraftment, and valid questionnaires were available in 120 (90%) patients. Mean age at KTx was 71.6 years (±4.3 years), 71% were male. Living donor was used in 21%, and preemptive KTx was performed in 30% of the recipients. Median waiting time for KTx from deceased donor was 16 months (range, 0.6-50.5 months). A total of 79 (66%) recipients had a Liu Comorbidity Index score of 3 or less.All HRQoL scores except the domain social function improved at 2 months postengraftment and remained stable or continued to improve at 1 year.HRQoL scores 12 months postengraftment were similar to those described in an age-matched general population except for the domain social function which remained at a significantly lower level. Time in dialysis was the most important variable associated with impaired HRQoL postengraftment. CONCLUSIONS HRQoL scores showed clinically significant improvement in older KTx recipients 1 year posttransplant.
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Affiliation(s)
- Kjersti Lønning
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Heldal
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Clinic of Internal Medicine, Telemark Hospital Trust, Skien, Norway
| | - Tomm Bernklev
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development, Vestfold Hospital Trust, Tønsberg, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Marit Helen Andersen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
| | - Nanna von der Lippe
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders Hartmann
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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15
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Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, Patel HV, Modi PR, Shah VR. Deceased Donor Renal Transplantation from Older Donors to Increase the Donor Pool. Int J Artif Organs 2018. [DOI: 10.1177/039139881203500906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vivek B. Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad - India
| | - Hargovind L Trivedi
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad - India
| | - Aruna V. Vanikar
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, IKDRC-ITS, Ahmedabad - India
| | - Pankaj R. Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad - India
| | - Manoj R. Gumber
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad - India
| | - Himanshu V. Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad - India
| | - Pranjal R. Modi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad - India
| | - Veena R. Shah
- Department of Anesthesia and Critical Care, IKDRC-ITS, Ahmedabad - India
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16
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Abstract
The old-for-old allocation policy used for kidney transplantation (KT) has confirmed the survival benefit compared to remaining listed on dialysis. Shortage of standard donors has stimulated the development of strategies aimed to expand acceptance criteria, particularly of kidneys from elderly donors. We have systematically reviewed the literature on those different strategies. In addition to the review of outcomes of expanded criteria donor or advanced age kidneys, we assessed the value of the Kidney Donor Profile Index policy, preimplantation biopsy, dual KT, machine perfusion and special immunosuppressive protocols. Survival and functional outcomes achieved with expanded criteria donor, high Kidney Donor Profile Index or advanced age kidneys are poorer than those with standard ones. Outcomes using advanced age brain-dead or cardiac-dead donor kidneys are similar. Preimplantation biopsies and related scores have been useful to predict function, but their applicability to transplant or refuse a kidney graft has probably been overestimated. Machine perfusion techniques have decreased delayed graft function and could improve graft survival. Investing 2 kidneys in 1 recipient does not make sense when a single KT would be enough, particularly in elderly recipients. Tailored immunosuppression when transplanting an old kidney may be useful, but no formal trials are available.Old donors constitute an enormous source of useful kidneys, but their retrieval in many countries is infrequent. The assumption of limited but precious functional expectancy for an old kidney and substantial reduction of discard rates should be generalized to mitigate these limitations.
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17
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Jozwik A, Domagala P, Kieszek R, Wszola M, Serwanska-Swietek M, Karpeta E, Gorski L, Bieniasz M, Jonas M, Berman A, Paczek L, Durlik M, Chmura A, Kwiatkowski A. Renal Transplantation Using Kidneys Procured From Elderly Donors Older Than 70 Years. Transplant Proc 2017; 48:1477-81. [PMID: 27496431 DOI: 10.1016/j.transproceed.2016.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/24/2016] [Accepted: 03/08/2016] [Indexed: 10/21/2022]
Abstract
AIM A major problem for the transplant society is a shortage of organs for transplantation compared with the number of patients on the waiting list. This study aimed to assess the results of the transplantation of kidneys procured from older donors. PATIENTS AND METHODS A total of 27 kidneys procured from donors age 70 years or older were transplanted between January 1, 2010, and April 25, 2015. These represented only 4.1% of the 657 kidneys transplanted from deceased donors during this period at the same center. RESULTS Delayed graft function (DGF) in the recipients of kidneys procured from donors age 70 or older occurred in 46.1% of patients, whereas the recipients of kidneys from younger donors showed DGF at a frequency of 32.7% (P = NS). The annual and 3-year survival rates of kidneys in the study group were 85% and 80%, respectively, and in the control group were 92.5% and 88.6%, respectively (P = NS). According to the Polish National Organ Procurement Organization (Poltransplant), the annual survival rate of a transplanted kidney in Poland stands at 89%, whereas the 3-year survival rate is 82%. We detected no significant posttransplantation differences in the serum creatinine concentration and in the estimated glomerular filtration rate between the study and control groups. The donor age and donor creatinine were the variables independently associated with DGF. CONCLUSIONS The results of transplantation of kidneys from elderly donors were comparable to those of transplantation from younger donors. Kidneys harvested from elderly donors should be used for a transplant after a preliminary assessment.
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Affiliation(s)
- A Jozwik
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - P Domagala
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland.
| | - R Kieszek
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Wszola
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Serwanska-Swietek
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - E Karpeta
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - L Gorski
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Bieniasz
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - M Jonas
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - A Berman
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - L Paczek
- Departments of Immunology, Transplantology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Departments of Transplantology and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - A Chmura
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Departments of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
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18
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Lønning K, Midtvedt K, Leivestad T, Reisæter AV, Line PD, Hartmann A, Heldal K. Are Octogenarians With End-Stage Renal Disease Candidates for Renal Transplantation? Transplantation 2016; 100:2705-2709. [PMID: 27861296 PMCID: PMC5120766 DOI: 10.1097/tp.0000000000001363] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elderly patients are the fastest-growing group in need of renal transplantation. This study puts focus on renal transplant recipients in their 80th year or longer at time of engraftment. Is there evidence to support an absolute upper age limit for renal transplantation? METHODS Recipients in their 80th year or longer, transplanted between 1983 and 2015, were included. Data were retrieved from the Norwegian Renal Registry in the end of October 2015. Graft and patient survivals were compared with recipients aged 70 to 79 years at transplantation. RESULTS Forty-seven patients older than 79 years were transplanted in the defined period. Median age 80.1 years, 81% were men. Median time on dialysis before transplantation was 18.5 months. All patients received an allograft from a deceased donor (median donor age, 61.8 years). In the death-censored graft survival model, there was no statistical difference between the groups. We found improved patient and graft survivals after introduction of mycophenolate mofetil and induction with basiliximab. Patients transplanted before 2000 had increased risk of death compared with those transplanted after 2000 (hazard ratio, 3.2; 95% confidence interval, 1.2-8.7). Median uncensored graft survival for patients transplanted after the year 2000 was 5.0 year (95% confidence interval, 2.4-7.6). Median patient survival was 5.0 years (3.1-6.9) and 5-year patient survival was 55%. CONCLUSIONS Age by itself should not be an absolute contraindication against renal transplantation. An estimated 5-year survival rate of 55% post-engraftment for an 80-year-old patient is in our opinion more than acceptable.
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Affiliation(s)
- Kjersti Lønning
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Torbjørn Leivestad
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anna V. Reisæter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders Hartmann
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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19
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Peters-Sengers H, Berger SP, Heemskerk MBA, Al Arashi D, Homan van der Heide JJ, Hemke AC, Ten Berge IJM, Idu MM, Betjes MGH, van Zuilen AD, Hilbrands LB, de Vries APJ, Nurmohamed AS, Christiaans MH, Ernest van Heurn LW, de Fijter JW, Bemelman FJ. Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors. J Am Soc Nephrol 2016; 28:621-631. [PMID: 27729570 DOI: 10.1681/asn.2015080879] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 07/08/2016] [Indexed: 12/11/2022] Open
Abstract
An increasing number of elderly patients (≥65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (≥18 years) who received a first DBD or DCD kidney during 2002-2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type. In multiple logistic regression analysis, elderly recipients of elderly DCD kidneys experienced more delayed graft function and acute rejection than did elderly recipients of young DBD kidneys (odds ratios 10.43 [95% confidence interval (95% CI), 5.75 to 18.91] and 2.78 [95% CI, 1.35 to 5.73], respectively). In Cox regression analysis, elderly recipients of elderly DCD kidneys had a 5-year mortality risk higher than that of elderly recipients of young DBD kidneys (hazard ratio, 1.86; 95% CI, 1.15 to 3.02). Elderly recipients of elderly kidneys had a 5-year mortality rate comparable to that of waitlisted elderly patients remaining on dialysis. Among elderly recipients, 63.8% of those who received elderly DCD kidneys, 45.5% of those who received elderly DBD kidneys, and approximately 26% of those who received young DBD or DCD kidneys had an eGFR<30 ml/min per 1.73 m2 (including primary nonfunction) after 1 year. In conclusion, improving donor selection and preservation is warranted if the allocation of elderly DCD grafts to elderly recipients is to be expanded.
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Affiliation(s)
| | - Stefan P Berger
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin B A Heemskerk
- Netherlands Organ Transplant Registry, Dutch Transplant Foundation, Leiden, The Netherlands
| | | | | | - Aline C Hemke
- Netherlands Organ Transplant Registry, Dutch Transplant Foundation, Leiden, The Netherlands
| | | | - Mirza M Idu
- Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel G H Betjes
- Department of Nephrology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aiko P J de Vries
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Azam S Nurmohamed
- Department of Nephrology, Vrije University Medical Center, Amsterdam, The Netherlands; and
| | | | | | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Pérez-Sáez MJ, Arcos E, Comas J, Crespo M, Lloveras J, Pascual J. Survival Benefit From Kidney Transplantation Using Kidneys From Deceased Donors Aged ≥75 Years: A Time-Dependent Analysis. Am J Transplant 2016; 16:2724-33. [PMID: 27004984 DOI: 10.1111/ajt.13800] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/26/2016] [Accepted: 03/13/2016] [Indexed: 01/25/2023]
Abstract
Patients with end-stage renal disease have longer survival after kidney transplantation than they would by remaining on dialysis; however, outcome with kidneys from donors aged ≥75 years and the survival of recipients of these organs compared with their dialysis counterparts with the same probability of obtaining an organ is unknown. In a longitudinal mortality study, 2040 patients on dialysis were placed on a waiting list, and 389 of them received a first transplant from a deceased donor aged ≥75 years. The adjusted risk of death and survival were calculated by non-proportional hazards analysis with being transplanted as a time-dependent effect. Projected years of life since placement on the waiting list was almost twofold higher for transplanted patients. Nonproportional adjusted risk of death after transplantation was 0.44 (95% confidence interval [CI] 0.61-0.32; p < 0.001) in comparison with those that remained on dialysis. Stratifying by age, adjusted hazard ratios for death were 0.17 (95% CI 0.47-0.06; p = 0.001) for those aged <65 years, 0.56 (95% CI 0.92-0.34; p = 0.022) for those aged 65-69 years and 0.82 (95% CI 1.28-0.52; p = 0.389) for those aged ≥70 years. Although kidney transplantation from elderly deceased donors is associated with reduced graft survival, transplanted patients have lower mortality than those remaining on dialysis.
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Affiliation(s)
- M J Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.,Institut Mar d'Investigacions Médiques, Barcelona, Spain
| | - E Arcos
- Organització Catalana de Trasplantaments, Barcelona, Spain
| | - J Comas
- Organització Catalana de Trasplantaments, Barcelona, Spain
| | - M Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.,Institut Mar d'Investigacions Médiques, Barcelona, Spain
| | - J Lloveras
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.,Institut Mar d'Investigacions Médiques, Barcelona, Spain
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21
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Scalea JR, Redfield RR, Muth BL, Mohamed M, Wilson NA, Ellis TM, Kaufman DB, Djamali A. Older kidney transplant patients experience less antibody-mediated rejection: a retrospective study of patients with mild to moderate sensitization. Clin Transplant 2015; 29:1090-7. [DOI: 10.1111/ctr.12632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 01/30/2023]
Affiliation(s)
- Joseph R. Scalea
- Division of Transplantation; Department of Surgery; University of Wisconsin; Madison WI USA
| | - Robert R. Redfield
- Division of Transplantation; Department of Surgery; University of Wisconsin; Madison WI USA
| | - Brenda L. Muth
- Division of Nephrology; Department of Medicine; University of Wisconsin; Madison WI USA
| | - Maha Mohamed
- Division of Nephrology; Department of Medicine; University of Wisconsin; Madison WI USA
| | - Nancy A. Wilson
- Division of Nephrology; Department of Medicine; University of Wisconsin; Madison WI USA
| | - Thomas M. Ellis
- Department of Surgery; HLA Laboratory; University of Wisconsin; Madison WI USA
| | - Dixon B. Kaufman
- Division of Transplantation; Department of Surgery; University of Wisconsin; Madison WI USA
| | - Arjang Djamali
- Division of Nephrology; Department of Medicine; University of Wisconsin; Madison WI USA
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22
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Dreyer GJ, Hemke AC, Reinders MEJ, de Fijter JW. Transplanting the elderly: Balancing aging with histocompatibility. Transplant Rev (Orlando) 2015; 29:205-11. [PMID: 26411382 DOI: 10.1016/j.trre.2015.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/30/2015] [Accepted: 08/30/2015] [Indexed: 01/10/2023]
Abstract
Across the world, the proportions of senior citizens (i.e. those ≥65years) increase rapidly and are predicted to constitute over 25% of the general population by 2050. In 2012 already 48% of the population with end stage renal disease (ESRD) was aged 65years or older. Transplantation is considered the preferred treatment option for ESRD offering survival advantage over long-term dialysis in the majority of patients. Indeed, acceptable outcomes have been documented for selected patients over the age of 70years or even cases over 80years. The reality of organ scarcity and prolonged waiting times for a deceased donor kidney transplantation, however, indicate that at best 50% of the selected elderly may have realistic expectations to receive a timely transplant offer. By choice or medical selection, access to transplantation also decreases with increasing age. In order to expedite the chance for elderly to receive a kidney transplant dedicated allocation systems have been developed. These allocation systems, like the Eurotransplant Senior Program (ESP), support preferential local allocation of kidneys from older donors to older patients in order to match recipient and graft life while disregarding histocompatibility for HLA antigens. The consequence has been more acute rejection episodes and an increase in immunosuppressive load. In the elderly, the most common cause of graft loss is death with functioning graft and death from infectious diseases is one of the dominant causes. The Eurotransplant Senior DR-compatible Program (ESDP) was designed to further improve the perspective of successful transplantation in the elderly in terms of life and quality of life by re-introducing matching criteria for HLA-DR in the old-for-old algorithm.
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Affiliation(s)
- G J Dreyer
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - A C Hemke
- Nefrovision/Renine, Dutch Transplant Foundation, Leiden, The Netherlands
| | - M E J Reinders
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
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Yoo KD, An JN, Kim CT, Cho JH, Kim CD, Park SK, Chae DW, Oh YK, Lim CS, Kim YS, Kim YH, Lee JP. Clinical outcomes in Asian elderly kidney transplant recipients: a multicenter cohort study. Transplant Proc 2015; 47:600-7. [PMID: 25891695 DOI: 10.1016/j.transproceed.2015.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The kidney transplantation rate in elderly patients is increasing rapidly. However, the clinical outcomes of kidney transplantation in elderly patients have not yet been thoroughly evaluated. METHODS This multicenter cohort study included adult kidney transplant recipients (KTRs) admitted to five major tertiary hospitals in Korea between 1997 and 2012. A total of 3,565 adult participants were enrolled. Patient survival, allograft survival, and biopsy-proven acute rejection (BPAR) of 242 elderly recipients (≥ 60 years) were assessed and compared with those of a younger population. RESULTS Patients were divided into five groups according to age at time of transplantation. The proportion of elderly patients was 6.7 % (mean age, 63.1 ± 2.7 years; n = 242). The numbers of male patients (69.4%), those with diabetes mellitus history (36.3%), and those with pretransplantation ischemic heart disease history (17.7%) were significantly higher in the elderly group than in the younger age groups. Elderly patients were more likely to receive a cadaveric kidney, and overall mortality rates were significantly higher in the elderly patients (1-year survival 93.3%, 5-year survival 91.3%). However, death-censored allograft survival rate and BPAR were not affected by patient age (P = .104 and .501, respectively). Among the elderly, BPAR and female donors were independent risk factors for allograft loss. CONCLUSION The overall survival rate of the elderly KTRs was significantly lower than that of younger KTRs. However, the death-censored allograft survival rate did not differ between groups. Kidney transplantation should not be stagnated especially in elderly patients with end-stage renal disease.
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Affiliation(s)
- K D Yoo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J N An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C T Kim
- School of Public Health, Seoul National University, Seoul, Korea
| | - J H Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - C D Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - S K Park
- Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - D W Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Y K Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C S Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Y S Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Y H Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea.
| | - J P Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
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Cronin AJ. Ethical and legal issues related to the donation and use of nonstandard organs for transplants. Anesthesiol Clin 2013; 31:675-687. [PMID: 24287346 DOI: 10.1016/j.anclin.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Transplantation of nonstandard or expanded criteria donor organs creates several potential ethical and legal problems in terms of consent and liability, and new challenges for research and service development; it highlights the need for a system of organ donation that responds to an evolving ethical landscape and incorporates scientific innovation to meet the needs of recipients, but which also safeguards the interests and autonomy of the donor. In this article, the use of deceased donor organs for transplants that fail to meet standard donor criteria and the legitimacy of interventions and research aimed at optimizing their successful donation are discussed.
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Affiliation(s)
- Antonia J Cronin
- NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, MRC Centre for Transplantation, Guy's Hospital, King's College London, Fifth Floor Tower Wing, London SE1 9RT, UK.
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The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors. Kidney Int 2013; 85:1161-8. [PMID: 24284518 DOI: 10.1038/ki.2013.461] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 08/29/2013] [Accepted: 09/05/2013] [Indexed: 11/08/2022]
Abstract
Reproducibility and predictive value on outcome are the main criteria to evaluate the utility of histological scores. Here we analyze the reproducibility of donor biopsy assessment by different on-call pathologists and the retrospective evaluation by a single renal pathologist blinded to clinical outcomes. We also evaluate the predictive value on graft outcome of both evaluations. A biopsy was performed in donors with any of the following: age≥55 years, hypertension, diabetes, creatinine>1.5 mg/dl, or stroke. Glomerulosclerosis, interstitial fibrosis, tubular atrophy, intimal thickening, and arteriolar hyalinosis evaluated according to the Banff criteria were added to obtain a chronic score. Biopsies were classified as mild (≥3), intermediate (4-5), or advanced (6-7) damage, and unacceptable (≥8) for transplantation of 127 kidneys biopsied. Weighted κ value between both readings was 0.41 (95% CI: 0.28-0.54). Evaluation of biopsies by the renal pathologist was significantly and independently associated with estimated 12-month glomerular filtration rate and a significant composite outcome variable, including death-censored graft survival and time to reach an estimated glomerular filtration rate<30 ml/min per 1.73 m2. Thus, there was no association between readings of on-call pathologists and outcome. The lack of association between histological scores obtained by the on-call pathologists and graft outcome suggests that a specific training on renal pathology is recommended to optimize the use of kidneys retrieved from expanded criteria donors.
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Nickeleit V. Foretelling the future: predicting graft outcome by evaluating kidney baseline transplant biopsies. J Am Soc Nephrol 2013; 24:1716-9. [PMID: 23990674 PMCID: PMC3810094 DOI: 10.1681/asn.2013070761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Volker Nickeleit
- Division of Nephropathology, Department of Pathology and Laboratory Medicine, The University of North Carolina, Chapel Hill, North Carolina
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Heldal K, Thorarinsdottir S, Hartmann A, Leivestad T, Reisæter AV, Foss AE, Midtvedt K. Induction with interleukin-2 antagonist for transplantation of kidneys from older deceased donors: an observational study. Transplant Res 2013; 2:11. [PMID: 23799993 PMCID: PMC3702442 DOI: 10.1186/2047-1440-2-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/18/2013] [Indexed: 12/02/2022] Open
Abstract
Background The most important limiting factor in kidney transplantation is the scarcity of donor organs. Consequently, there is an increased use worldwide of kidneys from older deceased donors. High donor age is a known risk factor for acute cellular rejection and premature graft failure, and the optimal immunosuppressive regimen in these circumstances remains to be established. Methods We investigated whether induction treatment with an interleukin 2 (IL-2) receptor antagonist improves graft survival and reduces rejection episodes in recipients of kidneys from deceased donors aged ≥ 60 years. Data were retrieved for all recipients transplanted at our center from 2004 to 2009 with a kidney from a deceased donor aged > 60 years. The outcome was compared between recipients treated with (IL-2 plus) or without (IL-2 minus) an IL-2 receptor antagonist. All recipients received a calcineurin inhibitor, steroids and mycophenolate. Results A total of 232 first-transplant recipients were included (IL-2 plus = 149, IL-2 minus = 83). IL-2 minus was associated with increased risk of early acute rejection (OR 2.42; 95% CI 1.25 to 4.68, P = 0.009) and steroid-resistant rejection (OR 8.04; 2.77 to 23.25, P< 0.001). IL-2 plus patients had superior two-year estimated uncensored (87% versus 70%, P = 0.001) and death-censored (95% versus 79%, P< 0.001) graft survival. Conclusions Induction treatment with IL-2 receptor antagonist was associated with a reduction in acute rejection episodes and improved two-year graft survival in patients transplanted with kidneys from older deceased donors.
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Affiliation(s)
- Kristian Heldal
- Clinic of Internal Medicine, Telemark Hospital, 3710, Skien, Norway.
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Kidney Transplantation Using Donors Over 70 Years Old: Are the Criteria for Organ Allocation Too Expanded? Transplant Proc 2012; 44:2289-92. [DOI: 10.1016/j.transproceed.2012.07.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Heldal K, Midtvedt K. Doctor, Should I Remain on Dialysis or Accept the ECD Kidney Offered to Me? Am J Kidney Dis 2012; 59:748-50. [DOI: 10.1053/j.ajkd.2012.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 03/14/2012] [Indexed: 11/11/2022]
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Lim WH, Dogra G, Chadban SJ, Campbell SB, Clayton P, Cohney S, Russ GR, McDonald SP. Lack of impact of donor age on patient survival for renal transplant recipients ≥60years. Transpl Int 2012; 25:401-8. [PMID: 22340432 DOI: 10.1111/j.1432-2277.2012.01429.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There has been an increase in the number of older patients on the transplant waiting list and acceptance of older donor kidneys. Although kidneys from older donors have been associated with poorer graft outcomes, whether there is a differential impact of donor age on outcomes in older recipients remains unclear. The aim of this study was to evaluate the effect of donor age on graft and patient survival in renal transplant (RT) recipients ≥60years. Using the Australia and New Zealand Dialysis and Transplant Registry, outcomes of 1,037 RT recipients ≥60years between 1995 and 2009 were analyzed. Donor age groups were categorized into 0-20, >20-40, >40-60, and >60years. Compared with recipients receiving donor kidneys >60years, those receiving donor kidneys >20-40years had lower risk of acute rejection (odds ratio 0.46, 95% CI 0.27, 0.79; P<0.01) and death-censored graft failure (HR 0.37, 95% CI 0.19, 0.72; P<0.01). There was no association between donor age groups and death. With a corresponding growth in the availability of older donor kidneys and the observed lack of association between donor age and patient survival in RT recipients ≥60years, preferential allocation of older donor kidneys to RT recipients ≥60years may not disadvantage the life expectancy of these patients.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
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TOFT BIRGITTEG, FEDERSPIEL BIRGITTEH, SØRENSEN SØRENS, BAGI PER, NIELSEN HENNINGB, ANDERSEN CLAUSB. A histopathological score on baseline biopsies from elderly donors predicts outcome 1 year after renal transplantation. APMIS 2011; 120:182-6. [DOI: 10.1111/j.1600-0463.2011.02824.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heldal K, Hartmann A, Leivestad T, Lien B, Foss AE, Midtvedt K. Renal transplantation is also an option for patients over 70. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:2004-7. [PMID: 22016126 DOI: 10.4045/tidsskr.10.1391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Kidney transplantation is generally regarded as the best treatment option for patients with end-stage renal disease. Because of an increase in the elderly population, the number of elderly patients with end-stage renal disease is expected to increase. The scope of this paper is to present existing knowledge about the survival after kidney transplantation of patients over 70 years of age at the time of transplantation. MATERIAL AND METHODS The paper is based on existing literature retrieved through a systematic search in MEDLINE as well as on the authors' own experience and research. RESULTS Among patients who fulfill the established medical criteria, kidney transplantation results in better survival than lifelong dialysis treatment. The best prognosis is achieved if time on dialysis prior to transplantation is reduced and acute rejection episodes are avoided after transplantation. INTERPRETATION Kidney transplantation is a safe treatment for selected elderly patients with end-stage renal disease. Given a sufficient supply of organs, selected patients over 70 years of age with end-stage renal disease should be offered kidney transplantation following a standard medical assessment.
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Affiliation(s)
- Kristian Heldal
- Clinic of Internal Medicine, Telemark Hospital Skien, Norway.
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Midtvedt K, Namtvedt T, Scott H, Abedini S, Rocke JC, Dørje C, Foss S, Christen U, Hagness M, Hartmann A. Single transplanted kidneys from a 90-year-old deceased donor perform acceptably at 1 year. Transplant Proc 2011; 43:2107-9. [PMID: 21693337 DOI: 10.1016/j.transproceed.2011.01.192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 01/19/2011] [Indexed: 11/29/2022]
Abstract
Most centers are reluctant to accept expanded criteria donors above 70 to 75 years of age. We accepted kidneys from a 90-year-old male and report the 1-year outcome. The kidneys were used as single transplants and both had immediate graft function. Recipient A was a 71-year-old male, with cold ischemia time of 4 hours 49 minutes. One rejection was successfully treated with intravenous methylprednisolone. At 1 year, serum creatinine was 146 μmol/L with estimated glomerular filtration rate (eGFR) 41 mL/min. Recipient B was a 79-year-old male with known panel-reactive antibody positivity prior to transplantation. Cold ischemia time was 10 hours 4 minutes. He experienced no rejections. At 1 year serum-creatinine was 99 μmol/L with eGFR 63 mL/min. Both recipients performed a surveillance biopsy at 1 year with identical findings: interstitial fibrosis and tubular atrophy grade 1 with moderate to severe arteriolosclerosis. We conclude that both kidneys performed acceptably 1 year after engraftment. The use of old kidneys in old recipients gives them a properly functioning kidney and improves quality of life. Longer observation is needed.
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Affiliation(s)
- K Midtvedt
- Department of Specialized Medicine and Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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Veroux M, Grosso G, Corona D, Mistretta A, Giaquinta A, Giuffrida G, Sinagra N, Veroux P. Age is an important predictor of kidney transplantation outcome. Nephrol Dial Transplant 2011; 27:1663-71. [PMID: 21926404 DOI: 10.1093/ndt/gfr524] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Donor and recipient age may have an impact on the renal transplant outcome. Kidney transplantation from older donors may result in a worse outcome, and the survival benefit of kidney transplantation compared with dialysis may be reduced. The aim of this study was to evaluate the impact of donor and recipient age on kidney transplant outcome. MATERIALS AND METHODS Two hundred and twenty-three recipients of kidney transplants performed at our institution between 2002 and 2007 were analysed. The role of donor and recipient age matching on survival rate were investigated performing the Kaplan-Meier survival time analysis by decades, considering the donor's age of 60 and 70 years. The Cox proportional hazard uni- and multivariate regressions were also performed. Finally, Kaplan-Meier survival time analysis was performed to assess survival rates of patients transplanted stratified by donor age compared with wait-listed renal transplant candidates. RESULTS Elderly recipients had a significant lower graft and patient survival as well as a significantly higher risk of graft loss and patient death. Recipients younger and older than 65 years of age were at higher risk of graft loss if they received grafts from donors>65 years [hazard ratio (HR)=2.59, 95% confidence interval (CI): 1.12-6 and HR=5.65, 95% CI: 2.31-13.79, respectively]. Elderly recipients displayed a worse survival compared with transplant candidates on the waiting list. CONCLUSIONS Age is an important predictor of kidney transplantation outcome. Kidney transplantation does not offer a significant survival benefit in the intermediate term, compared to the waiting list, to elderly recipients transplanted with grafts from older donors. However, it cannot be excluded that it is still possible that there is a long-term benefit of transplantation over dialysis in this group of patients.
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Affiliation(s)
- Massimiliano Veroux
- Department of Surgery, Transplantation and Advanced Technologies, Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.
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Single-center experience with kidney transplantation using deceased donors older than 75 years. Transplantation 2011; 92:76-81. [PMID: 21546867 DOI: 10.1097/tp.0b013e31821d2687] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Use of kidneys from donors aged 75 years and older is controversial. The purpose of this study was to evaluate the outcome of kidney transplantation (KT) involving these expanded criteria donors. MATERIALS AND METHODS From January 2001 to November 2009, 52 patients were transplanted with grafts from deceased donors aged 75 years and older. Donor and recipient data and intra- and postoperative variables were analyzed by univariate and multivariate regression analyses. Graft and patient survival were calculated using the Kaplan-Meier method. RESULTS Forty-one single and 11 double KTs were performed. Median recipient age was 66 years. After a median follow-up of 30 months, 37 of 52 patients are alive, 30 with functioning grafts (81%). Graft and patient survival rates at 3 and 5 years are 63% and 53%, and 78% and 64%, respectively. Double KT was significant predictor for graft survival by multivariate analysis. Five-year graft survival for single and double KT was 41% and 90%, respectively (P=0.0394). Comorbidity Index, hospital stay, acute rejection reaction, re-KT, and induction immunosuppressive therapy with interleukin-2 were significant predictors for patient survival by univariate analysis. Hospital stay and induction immunosuppression therapy reached multivariate significance. Double KT, cold ischemia time, and Comorbidity Index were found potential predictors of delayed graft function in our series. CONCLUSIONS Fairly good long-term outcome of KT from donors aged 75 years and older can be achieved in elderly recipients with low comorbidities when dual kidney grafting is used and when re-transplantations and high grade surgical complications are avoided.
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Galeano C, Marcén R, Jimenez S, Fernández Rodríguez A, Sosa H, Villafruela JJ, Teruel JL, Burgos FJ, Quereda C. Utilization of elderly kidney donors (>70 years) does not affect graft survival in the medium term. Transplant Proc 2011; 42:3935-7. [PMID: 21168591 DOI: 10.1016/j.transproceed.2010.08.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 08/30/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The need for organs for renal transplantation has encouraged the use of grafts from increasingly older donors. Earlier studies performed in Spain have shown the suitability of donors aged 60-65 years. In this single-center study, we evaluated our results using donors >70 years old. METHODS We evaluated 401 primary transplantations performed from January 2000 to December 2009. Their initial immunosuppression was a tacrolimus-based (n = 324), cyclosporine-based (n = 70) or calcineurin inhibitor-free (n = 7) regimen patients. Recipients were classified according to the donors age: <50 (42.6%); 50-70 (39.7%) and >70 (17.5%) years. RESULTS There were no differences in recipient or donor gender, time on dialysis, cold ischemia, delayed graft function, or acute rejection episodes. However, the mean age was higher among patients who received grafts from donors >70 years old; 42.5 ± 12.4 years for <50, 58.1 ± 8.2 years for 50-70, and 65.7 ± 7.2 years for >70; (P = .000). The serum creatinine at 12 months was increased according to the age of the donor; 1.4 ± 0.6, 1.8 ± 0.6, 70 and 1.7 ± 0.5 mg/dL, respectively (P = .001). The graft survival rates at 5 years were 81%, 74%, and 70%, respectively (P = .519). Upon multivariate analysis only HLA-DR mismatches, delayed graft function, and acute rejection episodes were associated with graft loss. Patient survival rates (86%) at 5 years were similar among recipients from donors aged 50-70 and >70 years, but higher (96%) for those who received a graft from a donor <50 years (P = .003). CONCLUSIONS Nearly 20% of donors were >70 years old in our study. Their kidneys displayed excellent short-term outcomes.
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Affiliation(s)
- C Galeano
- Nephrology Department, Hospital Ramón y Cajal, Madrid, Spain.
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Kahu J, Kyllönen L, Räisänen-Sokolowski A, Salmela K. Donor risk score and baseline biopsy CADI value predict kidney graft outcome. Clin Transplant 2011; 25:E276-83. [DOI: 10.1111/j.1399-0012.2011.01401.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mueller TF, Solez K, Mas V. Assessment of kidney organ quality and prediction of outcome at time of transplantation. Semin Immunopathol 2011; 33:185-99. [PMID: 21274534 DOI: 10.1007/s00281-011-0248-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 01/13/2011] [Indexed: 12/13/2022]
Abstract
The critical importance of donor organ quality, i.e., number of surviving nephrons, ability to withstand injury, and capacity for repair in determining short- and long-term outcomes is becoming increasingly clear. This review provides an overview of studies to assess donor kidney quality and subsequent transplant outcomes based on clinical pathology and transcriptome-based variables available at time of transplantation. Prediction scores using clinical variables function when applied to large data sets but perform poorly for the individual patient. Histopathology findings in pre-implantation or post-reperfusion biopsies help to assess structural integrity of the donor kidney, provide information on pre-existing donor disease, and can serve as a baseline for tracking changes over time. However, more validated approaches of analysis and prospective studies are needed to reduce the number of discarded organs, improve allocation, and allow prediction of outcomes. Molecular profiling detects changes not seen by morphology or captured by clinical markers. In particular, molecular profiles provide a quantitative measurement of inflammatory burden or immune activation and reflect coordinated changes in pathways associated with injury and repair. However, description of transcriptome patterns is not an end in itself. The identification of predictive gene sets and the application to an individualized patient management needs the integration of clinical and pathology-based variables, as well as more objective reference markers of transplant function, post-transplant events, and long-term outcomes.
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Affiliation(s)
- Thomas F Mueller
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Deceased donor organ transplantation with expanded criteria donors: a single-center experience from India. Transplant Proc 2010; 42:171-4. [PMID: 20172307 DOI: 10.1016/j.transproceed.2009.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Deceased donor organ transplantation (DDOT) accounts for <4% of renal transplants in India. Many volunteers come forth for organ donation with increasing awareness; unfortunately, the majority are marginal donors, but their rejection would hamper the DDOT program. Judicious use of marginal organs is a challenge for developing countries. PATIENTS AND METHODS We performed 29 renal transplants from 21 expanded criteria donors (ECD) out of 115 DDOT between January 2006 to April 2009-10 dual (DKT) and 19 single (SKT). Fourteen donors had hypertension, a cerebrovascular accident as the cause of death, 9 had both, and 4 had diabetes. Mean donor age was 70.3 +/- 8.9 years. Decisions on the procedure were based upon frozen section biopsy in 13 of 21 donors. Mean DKT donor age was 76 +/- 9.7 years versu 64 +/- 5.7 years of SKT donors. The native kidney diseases were chronic glomerulonephritis (n = 14), diabetic nephropathy (n = 7), tubulointerstitial nephritis (n = 4) and polycystic kidney disease, focal segmental glomerulosclerosis, lupus nephritis and patchy cortical necrosis, (n = 1 each). Mean recipient age of DKT versus SKT was 43.5 versus 42.3 years. All recipients received rabbit anti-thymocyte globulin, followed by steroid, mycophenolate mofetil/calcinueurin inhibitor. RESULTS Over a mean follow-up of 341 days, the mean serum creatinine (SCr) of 25/29 patients was 1.60 mg/dL (range, 1.0-2.6). The mean SCr of SKT patients was 1.59 +/- 0.63 mg/dL and of DKT, 1.62 +/- 0.48 mg/dL. Ten patients had delayed graft function and 11 had biopsy proven acute tubular necrosis. Seven (24%) patients had rejection (grade 3 Banff update '05, type IA; 4, type 2A); 6 responded to antirejection; 1 graft was lost at 7 months due to chronic rejection. Three (10.3%) patients were lost, 1 each due to AMI, sepsis, and CMV disease. CONCLUSION In the circumstances of organ shortage, DDOT with expanded criteria donor is a feasible option.
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Current world literature. Curr Opin Pediatr 2010; 22:246-55. [PMID: 20299870 DOI: 10.1097/mop.0b013e32833846de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Heldal K, Hartmann A, Grootendorst DC, de Jager DJ, Leivestad T, Foss A, Midtvedt K. Benefit of kidney transplantation beyond 70 years of age. Nephrol Dial Transplant 2009; 25:1680-7. [PMID: 20038521 PMCID: PMC2856560 DOI: 10.1093/ndt/gfp681] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background. Kidney transplantation generally improves long-term survival in patients with end-stage renal disease. However, in patients older than 70 years of age, only limited data are available that directly compare the potential survival benefit of transplantation versus dialysis. Methods. All patients aged above 70 years who started dialysis between 1990 and 2005 and were waitlisted for kidney transplantation were included in the study. They were categorized according to time periods of inclusion (1990–99 vs 2000–05). Survival rates of altogether 286 dialysis patients were analyzed with a Kaplan–Meier model, as well as with a time-dependent Cox model. Comparisons were made between those who received a transplant and those who did not, and further between the two time periods. Results. Median age at inclusion was 73.6 years (interquartile range 72.3–75.6). Two hundred and thirty-three patients (81%) received a kidney transplant during follow-up. Transplant recipients experienced an increased mortality in the first year after transplantation when compared to waitlisted patients. Patients starting dialysis between 1990 and 1999 had no significant long-term benefit of transplantation; HR for death 1.01 (0.58–1.75). In contrast, there was a substantial long-term benefit of transplantation among those starting dialysis after 2000; HR for death 0.40 (0.19–0.83), P = 0.014. Conclusions. Survival after kidney transplantation in patients over 70 years has improved during the last decade and offers a survival advantage over dialysis treatment. Our experience supports the use of kidney transplantation in this age group if an increased early post-operative risk is accepted. This transplant policy may be challenged for priority reasons.
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Affiliation(s)
- Kristian Heldal
- Section of Nephrology and Endocrinology, Clinic of Internal Medicine, Sykehuset Telemark, Norway.
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[Starting over]. Med Intensiva 2009; 33:431-3. [PMID: 19857912 DOI: 10.1016/j.medin.2009.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/10/2009] [Indexed: 11/21/2022]
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Richards L. Kidneys from old donors: tackling the organ shortage. Nat Rev Nephrol 2009. [DOI: 10.1038/nrneph.2009.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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