Differential Outcomes of Expanded-Criteria Donor Renal Allografts According to Recipient Age

Abstract

SummaryBackground and objectives Expanded-criteria donor (ECD) kidneys are used to expand the number of deceased-donor kidney transplants, often for elderly recipients. This study sought to determine whether older recipients had significantly worse outcomes from receiving ECD kidneys and whether outcomes of ECD versus standard-criteria donor (SCD) kidneys differed in younger recipients.Design, setting, participants, & measurements This is a single-center, retrospective review of all primary deceased-donor kidney transplantations performed between 2000 and 2005. Group 1 consisted of patients $60 years of age (n=189) who received an ECD (n=96) or an SCD (n=93) kidney. Group 2 consisted of patients 40-59 years of age (n=370) who received an ECD (n=105) or an SCD (n=265) kidney.Results Older recipients (group 1) who received ECD kidneys demonstrated significantly shortened 5-year actuarial patient and graft survival rates compared with older recipients of SCD allografts. Group 1 ECD recipients also had significantly worse outcomes than younger (group 2) ECD recipients. In multivariate analysis, ECD kidneys remained an independent predictor of poorer outcome in group 1.Conclusions Morbidity and mortality were increased in elderly recipients of ECD kidneys. These findings may have implications in kidney allocation policy developments that encourage placement of ECD kidneys for older recipients.

Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis

“…A total of 135 publications were excluded because the ECD definition was incorrect or lacking, and 82 because of statistical inadequacies in the survival analysis. Thirty‐two publications were finally included in this study . The corresponding main characteristics are summarized in Table .…”

“…Characteristics of donors, recipients, and transplantations are detailed in Table . Among the 32 publications, 25 (78%) also included SCD kidney recipients . Transplantation periods ranged from 1990 to 2010.…”

“…Most of the recipients were transplanted after 2000, earlier transplants being a posteriori reclassified as ECD/SCD. The information related to the Donation after Circulatory Death (DCD) was not specified in 19 publications (59%) . Seventeen publications described baseline clinical characteristics for both the ECD and SCD groups.…”

Survival Benefit in Older Patients Associated With Earlier Transplant With High KDPI Kidneys

“…14–17 A more recent analysis showed improved long-term patient survival benefits with higher KDPI kidneys (KDPI > 70%) in patients > 50 years old or at centers with median wait times > 33 months. 15 To date, there has been no examination of the long-term survival benefit according to the KDPI > 85% threshold that is now used for allocation or if survival advantages remain when evaluating patients over 60 years old separately.…”

Marginal Donors in Renal Transplantation

“…Mezrich et al [83] have recently reported that elderly patients over 60 years of age with kidneys transplanted from cadaveric marginal donors have a -year shorter patient and graft survival expectancy than that of elderly recipients of standard criteria donors. A similar analysis with 117 patients transplanted from deceased donors indicated a direct correlation between donor age and graft function at 10 years after renal transplantation [84].…”