Factors in Older Cadaveric Organ Donors Impacting on Renal Allograft Outcome

Abstract

Transplantation of renal allografts (RA) from older donors has become more common, despite conflicting data on outcome between reports from large series versus individual centres. Factors other than donor age per se may contribute to RA outcome. The outcome of RA procured from 114 older donors over 55 yr of age in NSW, between 1990 and 1997, was analysed. Corresponding donor factors, including demographics, medical history, inotrope use, major hypotension and findings at procurement, were also analysed. Of the potential RA, 8% were discarded and the remainder transplanted. Factors significantly associated with renal discard were pre‐transplantation donation biopsy abnormality (p<0.001) and a history of cardiovascular (CV) disease in the donor (p<0.02). Donor aortorenal atherosclerosis (AS; p<0.09) and a donor age of 65 yr or older (p<0.08) were common in the discard group. The never function rate was 7.6% and was associated with a history of a discarded partner kidney (p<0.05). The delayed graft function rate was 33% and was associated with a history of donor CV disease. At a median follow up of 5 yr, the death censored allograft failure rate was 24%. Allograft failure was associated with a history of donor hypertension (p<0.05). Donor AS (p<0.7) tended to have been more common in the allograft failure group. A number of cadaveric organ donor factors documented at procurement may be associated with inferior outcome of RA. These include biopsy abnormality, history of donor CV disease and history of donor hypertension. A donor age of 65 yr or older or significant visible aortorenal AS may also be factors. This retrospective review of kidneys procured from 114 older cadaveric organ donors identifies factors apart from donor age, which may have a negative impact on both allograft utilisation and outcome. Theses factors include renal biopsy abnormality, history of donor CV disease, discard of a partner kidney and donor hypertension. Visible AS in the donor aorta documented at renal procurement may also be a factor.

A Simple Clinico-Histopathological Composite Scoring System Is Highly Predictive of Graft Outcomes in Marginal Donors

“…As previously reported, we found that a donor history of hypertension was associated with a worse graft outcome (7,(29)(30)(31). The presence of hypertension is one of the most relevant factors to consider in the evaluation of the donor, as it underlies the crucial importance of evaluating arterial disease in elderly potential donors (7).…”

Biopsy of potential cadaveric renal allografts at the time of retrieval

“…Extensive atheroma of the aortorenal arterial vasculature was the most common cause for discardment of potential renal allografts during the control period. This mirrors our previously reported experience with older cadveric RA donors 7 . However, during the biopsy‐protocol period, RA biopsy findings taken in consideration with other factors became the most common cause for RA discardment in 8/24 (33%) cases.…”

Donor Tissue Characteristics Influence Cadaver Kidney Transplant Function and Graft Survival but Not Rejection

“…Donor factors influence initial graft function and survival (5)(6)(7)(8). In addition to donor age (9) and mode of brain death (10), other influential donor parameters include gender (11), whether the donor heart is beating (12), hypertension, and cardiovascular disease (13,14). The increased survival of kidney allografts from living donors compared with cadaver allografts with similar HLA mismatches is probably related, at least in part, to injury from brain death (15).…”