Long-term outcome of renal transplantation from octogenarian donors: A multicenter controlled study

Abstract

To assess whether biopsy-guided selection of kidneys from very old brain-dead donors enables more successful transplantations, the authors of this multicenter, observational study compared graft survival between 37 recipients of 1 or 2 histologically evaluated kidneys from donors older than 80 years and 198 reference-recipients of non-histologically evaluated single grafts from donors aged 60 years and younger (transplantation period: 2006-2013 at 3 Italian centers). During a median (interquartile range) of 25 (13-42) months, 2 recipients (5.4%) and 10 reference-recipients (5.1%) required dialysis (crude and donor age- and sex-adjusted hazard ratio [95% confidence interval] 1.55 [0.34-7.12], P = .576 and 1.41 [0.10-19.54], P = .798, respectively). Shared frailty analyses confirmed similar outcomes in a 1:2 propensity score study comparing recipients with 74 reference-recipients matched by center, year, donor, and recipient sex and age. Serum creatinine was similar across groups during 84-month follow-up. Recipients had remarkably shorter waiting times than did reference-recipients and matched reference-recipients (7.5 [4.0-19.5] vs 36 [19-56] and 40 [24-56] months, respectively, P < .0001 for both comparisons). Mean (± SD) kidney donor risk index was 2.57 ± 0.32 in recipients vs 1.09 ± 0.24 and 1.14 ± 0.24 in reference-recipients and matched reference-recipients (P < .0001 for both comparisons). Adverse events were similar across groups. Biopsy-guided allocation of kidneys from octogenarian donors permits further expansion of the donor organ pool and faster access to a kidney transplant, without increasing the risk of premature graft failure.

R Open Source Programming Code for Calculation of the Kidney Donor Profile Index and Kidney Donor Risk Index

“…Of note, even the recipients of kidneys with KDPI > 85% were at a much lower risk of death 2 years after transplant compared to those remaining on dialysis waiting for low-KDPI kidneys [13]. Moreover, such ECDs could be considered for the double kidney transplantation to a single recipient that provide better patient and graft survival in comparison to transplantation of such kidneys to 2 recipients [14, 15], and the use of the additional pre-transplant donor biopsy morphology score [16] secures the kidney transplantation from a high KDPI donor that otherwise may be discarded [17-20] and helps to allocate a donor organ to single or double transplantation. The results of the aforementioned studies highlight the important limitation of the current version of KDPI that could overestimate the prognostic weight of age based on the generalization from the total deceased donor population, and do not assume the specific constellation of parameters of a given donor.…”

Making Procurement Biopsies Important Again for Kidney Transplant Allocation

“…A multicenter controlled study showed that kidneys from octogenarian donors allocated to single or DOI: 10.1159/000499452 dual transplantation after a pretransplant biopsy provided comparable 7-year outcomes as single standard-criteria kidney transplants [20]. Most of these very old kidneys may have been discarded by a United Network of Organ Sharing center based on their KDPI scores (96-100%).…”

“…Most of these very old kidneys may have been discarded by a United Network of Organ Sharing center based on their KDPI scores (96-100%). Importantly, recipients of very old kidneys had remarkably shorter waiting times than recipients of younger grafts [20].…”

Is the kidney donor profile index (KDPI) universal or UNOS-specific?

“…DKT after a pre-transplant biopsy assessment despite their calculated KDPI scores (96-100%). The study provided comparable outcomes as single standard criteria kidney transplantation up to 7 years with the use of kidneys which had KDPI >96% 4. Those kidneys may have been discarded by a UNOS center based on their KDPI scores 1.…”