Deceased Donor Kidney Transplantation in the Eurotransplant Senior Program (ESP): A Single-Center Experience from 2008 to 2013

Abstract

Background:The aim of this study was to evaluate the outcome after transplantation of deceased allografts in donor/recipient pairs aged ³65 years enrolled in the Eurotransplant Senior Program (ESP). Material/Methods:In this retrospective cohort study we evaluated data from 89 patients transplanted under the ESP protocol from 2008 to 2013. Outcome parameters included graft and patient survival, rate of biopsy-proven acute rejections (BPAR), peri-and post-operative complications, tumor development, development of donor-specific antibodies (DSA), and the prognostic role of preimplantation biopsies. Results:One-year patient and allograft survival rates were 92.1% and 84.3%, respectively. During follow-up, 23 (26%) patients died; the major cause of death was sepsis, followed by cardiovascular events and malignancies. BPAR episodes were frequent within the first year (~33%) and overall were less common in patients treated with tacrolimus. Post-transplant malignancies were seen in 15 (17%) patients. During follow-up, 16 (18%) patients developed DSA; patients with delayed graft function (DGF) were more likely to develop DSA (p=0.029). A higher preimplantation biopsy score was associated with DGF but did not predict later graft outcome. Conclusions:The results highlight increased risks in ESP transplant candidates and the importance of careful surveillance of this patient group.

Transplantation of Marginal Organs: Immunological Aspects and Therapeutic Perspectives in Kidney Transplantation

“…Results from the Dutch Organ Transplant Registry, which is part of Eurotransplant and ESP, showed a 5-year death censored graft survival of 83.8% in DBD and 75.3% in DCD (98). In this old recipient population, delayed graft function was a strong risk factor of death (+40% risk) and of rejection (+57%) and DSA development (99).…”

Association of Kidney Donor Risk Index with the Outcome after Kidney Transplantation in the Eurotransplant Senior Program

“…In 2008, Frei et al published the outcomes of more than 1400 patients transplanted in the ESP [ 4 ] representing the largest published cohort so far. More recent data regarding the outcome of patients in the ESP has been limited to few single center experiences [ 11 – 14 ]. In these studies, patient and graft survival were comparable to our own results.…”

Fifteen-Year Analysis of Deceased Kidney Donation: A Single Transplant Center Experience in a Region of Northern Italy

“…Radhawa et al described a glomerulosclerosis rate ranging from 0% to 10% in patients aged 60–75 years and bioptic abnormalities in younger patients, showing that donor age alone may be a misleading criterion for organ classification and allocation [ 23 ]. In spite of the belief that the use of organs from elderly or marginal donors results in poorer post-transplant renal function and outcome [ 8 , 24 , 25 ], McGlynn et al proposed that the performance of an organ is more strictly correlated to its level of senescence rather than donor age itself. Some organs from older donors have proven to function adequately for many years, similarly to those from younger donors, and the explication might lie in the fact that biological age of the organ is a more effective predictor of graft outcome than its chronological age.…”