Age‐matching in renal transplantation

Waiser, Johannes; Schreiber, M. R.; Budde, Klemens; Fritsche, Lutz; Böhler, Torsten; Hauser, Ingeborg A.; Neumayer, Hans-H

doi:10.1093/ndt/15.5.696

Cited by 106 publications

(61 citation statements)

References 18 publications

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“…In contrast to the literature, 33,34 our data show that donor and recipient age do not affect the risk of recipient death and graft loss. Furthermore, we did not observe any effect of other important donorrelated factors, such as time spent in the intensive care unit, severe hypotension, or reversible cardiac arrest and renal function.…”

Section: Discussioncontrasting

confidence: 99%

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Napoli¹,

Grimaldi

Cacciatore

et al. 2014

Exp Clin Transplant

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Section: Discussioncontrasting

confidence: 99%

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Napoli¹,

Grimaldi

Cacciatore

et al. 2014

Exp Clin Transplant

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“…The obvious solution might be to harvest older kidneys for particular use in older recipients -a setting in which longterm graft survival is not as important as in younger recipients (4). This form of donor and recipient age matching is ethically fair and physiologically logical.…”

Section: Introductionmentioning

confidence: 99%

Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

Fritsche¹,

Hörstrup

Budde³

et al. 2003

American Journal of Transplantation

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114

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Allocation of kidneys from donors older than 64 years to recipients older than 64 years was started in 1999 to improve use of older donor kidneys. Kidneys are allocated locally without HLA-matching to keep cold ischemia short.We compared survival and rejection rates in elderly patients allocated in the old-for-old program (ESP) to patients aged 60 years and older based on HLA-matching, expected ischemia and waiting time (ETKAS).The 69 ESP patients were older (67.9 ± ± 2.5 vs. 63.9 ± ± 2.9 years), had older donors (71.2 ± ± 3.9 vs. 44.6 ± ± 14.5 years) and more HLA-mismatches (4.2 ± ± 1.2 vs. 1.6 ± ± 1.7) than the 71 ETKAS patients, while ischemia was shorter (7.8 ± ± 3.4 vs. 14.2 ± ± 5.5 h). ESP and ETKAS had similar graft (1-year: 83.6% vs. 86.9%) and patient survival (85.2% vs. 89.5%). With the introduction of ESP, use of older recipients and donors rose from less than 2% to 16% and 11%, respectively. Incidence of acute rejections was significantly higher in the ESP group (1 year: 43.2% vs. 27.4%) and significantly correlated with the degree of HLA-matching.Introduction of old-for-old allocation allows successful expansion of the donor and recipient pool without affecting patient and graft survival. HLA-matching should not be ignored, as the risk of acute rejection in elderly patients is substantial.

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“…Hariharan et al [79] reported that older kidneys have a better graft survival when transplanted into older recipients. Older to younger transplants were associated with the poorest graft survival outcomes in another study [80] . In using DCD kidneys from older donors there is a need to balance the likelihood of senescence, loss of nephron mass, reduced graft survival, increased risk of interstitial fibrosis, tubular atrophy, poor immediate function, progressive graft dysfunction and the higher impact of acute rejection on graft function with the benefits of the recipient being removed from dialysis.…”

Section: Agementioning

confidence: 88%

Kidney donation after cardiac death

Akoh¹

2012

WJN

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There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

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Age‐matching in renal transplantation

Abstract: Transplantation of kidneys from 'old' donors into 'young' recipients should be avoided, and these kidneys should be given to age-matched recipients.

Cited by 106 publications

References 18 publications

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Long-term Follow-up of Kidney Transplants in a Region of Southern Italy

Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

Kidney donation after cardiac death

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