Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

Abstract

Kidney transplantation (KT) is the therapy of choice for end-stage renal disease (ESRD). The ESRD population is aging and so are patients waiting for KT. New strategies have been made for increasing the donor and recipient pools, and as a consequence kidneys from older donors or donors with significant comorbidities, the so-called "expanded criteria donor" (ECD) kidneys, are used for transplantation. Although good outcomes have been achieved from ECD, several issues are still waiting for clarification and need to be discussed. The concept of age matching is accepted as a method to ameliorate utilization of these allografts, but an optimal and widely accepted strategy is still not defined. The development of machine perfusion and the dual kidney transplantation are techniques which further improve the outcome of transplants from ECD, but the described experiences are scarce or coming from small single institutional reports. Also due to age-related immune dysfunction and associated comorbidities, the elderly recipients are more susceptible to immunosuppression related complications (e.g., infections and malignancy), although a widely accepted and validated immunosuppressive regimen is still lacking. In this paper, we review the issues related to KT employing allografts from marginal donors with a particular interest for the elderly patients.

Clinical outcomes of kidney transplantation in older end‐stage renal disease patients: A nationwide cohort study

“…This finding suggested a tendency for kidneys from marginal donors, such as elderly individuals, to be allocated to elderly ESRD patients. 20 In regard to immune suppression regimen, the proportion of patients treated with cyclosporin instead of tacrolimus was higher in the elderly-LDKT group. This trend reflected a tendency to lower the intensity of immunosuppressant treatment in the elderly patients because of the high frequency of immunosuppression-related complications.…”

“…When we compared the baseline characteristics of elderly and young recipients, interestingly, in both LDKT and DDKT, donor age was significantly higher in the elderly group than in the young recipients. This finding suggested a tendency for kidneys from marginal donors, such as elderly individuals, to be allocated to elderly ESRD patients . In regard to immune suppression regimen, the proportion of patients treated with cyclosporin instead of tacrolimus was higher in the elderly‐LDKT group.…”

Marginal Donors in Renal Transplantation

“…Because the long-term outcome is not clear and there are a number of risks in renal transplantation from aged living donors, the usual practice in both United States and Europe is to use kidneys from aged living or deceased donors in elderly transplantation: the so-called "old-for-old" program [9,25]. This approach makes it possible for elderly ESRD patients to get more access to renal transplantation from expanded criteria deceased donor kidney and living marginal donors, whereas the distribution of optimal kidney donations is toward younger patients [26].…”

A kadáverdonor-vesék elfogadási gyakorlatának vizsgálata a debreceni transzplantációs centrumban

“…A marginális donorvese átültetését követően a betegek várható élettartama 5,1 évvel nőtt ahhoz képest, mint ha további dialíziskezelésben részesültek volna [13]. Dahmane és mtsai kutatása alapján nem volt szignifikáns különbség az SCD-és ECD-vesék 5 éves gafttúlélése között [14], ami alapján az ECD-vesék is elfogadható grafttúlélést nyújtanak, ezért elutasításuk gondos mérlegelést igényel [15].…”