Early experience with the ET Senior Program "Old For Old"; better to be number one?

Abstract

Eurotransplant offers a Senior porgram to extend the donor pool for renal transplantation. The study comprised 14 patients of the ET Senior (“Old For Old”) Program. Kidneys from five cadaveric donors were transplanted in pairs to ten recipients with a difference in cold ischemia time (CIT) of >4 h, and grouped according to CIT (group 1: patients that underwent transplantation first; group 2: patients that underwent transplantation second). CIT was shorter (5.5±2.0 h vs. 11.7±3.1 h, P<0.01), and the first day diuresis was higher (287.4 ml/h vs. 134.8 ml/h, P<0.05) in group 1 than in group 2. No patient in group 1 required dialysis. 3/5 patients in group 2. Rejection episodes occured more often in group 2 (5/5 vs. 3/5), and the hospital stay tended to be shorter in group 1 (33.0 days (27–43) vs. 54.2 days (27–112)). Our study confirms the positive effect of ultra‐short CIT on early graft function in marginal donors, despite overall short CIT. The increase in delayed graft function (DGF) may lead to an extended hospital stay and dialysis requirements. Efforts to realize simultaneous transplantation in two recipients seem necessary to optimize results.

Patient and Graft Survival in Older Kidney Transplant Recipients

“…Interestingly, neither delayed graft function nor primary-non function differed among the age groups, although donor age tended to be higher in the oldest recipient-group, which is likely attributable to the initiation of the Eurotransplant Senior Program in 1999 (30). Surgical complications, transplant nephrectomy, discharge on HD, and death during initial hospitalization were also not different among the three age groups; neither was renal function at discharge.…”

Long-Term Patient and Graft Survival in the Eurotransplant Senior Program: A Single-Center Experience

“…This study provides early evidence that the ESP, while expanding the donor pool and reducing time on waitlist, may yield at least comparable results for elderly transplant recipients compared to the conventional organ allocation algorithm. Only few evaluations of the ESP have been published to date (7)(8)(9)(10), and these studies were limited by relatively short follow-up and/or the use of historical controls. Smits et al (3) studied all 227 patients from the Eurotransplant Foundation network who received their donor organs through the ESP in 1999 and compared these to 102 controls.…”

Concordance of outcomes of pairs of kidneys transplanted into different recipients

“…In addition, peri‐operative factors such as prolonged cold ischaemia time (CIT) increase the risk of DGF [6,10,13]. Furthermore, previous paired kidney analyses comparing outcomes between first and second kidneys have demonstrated superior graft outcomes for the first kidney compared with the second kidney transplanted [14,15]. In our study, we seek to investigate the role of additional donor factors that are as yet unmeasured, which contribute to a recipients risk for DGF.…”