Kidney Transplantation Using Donors Over 70 Years Old: Are the Criteria for Organ Allocation Too Expanded?

Machado, Susana; Figueiredo, Nuno; Neves, Milton Alves das; Macário, Fernando; Alves, Rui; Mota, A.; Campos, Mário Júlio

doi:10.1016/j.transproceed.2012.07.031

Cited by 13 publications

(10 citation statements)

References 11 publications

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“…The present study is limited by the sample size, and a larger cohort would be required to explore the impact of different serum creatinine cutoffs, although large observational studies would www.nature.com/scientificreports/ also be limited due to the reluctance to accept very-old donors' kidney with a last serum creatinine above 1.5 mg/ dl. Overall death-censored and death-uncensored 5-year graft survival rates were 77% and 59% respectively in line with previous reports [13][14][15][16][17][18][19][20] (Table 6). These results may be considered as acceptable, since the median age of recipients was 66 (63-72) years, close to a so-called "old-for-old" allocation.…”

Section: Discussionsupporting

confidence: 91%

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Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors

Maanaoui

François

Bouyé

et al. 2021

Sci Rep

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As the use of elderly kidney donors for transplantation is increasing with time, there is a need to understand which factors impact on their prognosis. No data exist on the impact of an impaired renal function (IRF) in such population. 116 kidney recipients from deceased kidney donors over 70 years were included from 2005 to 2015 in a single-center retrospective study. IRF before organ procurement was defined as a serum creatinine above 1.0 mg/dl or a transient episode of oligo-anuria. Mean ages for donors and recipients were respectively 74.8 ± 3.5 and 66.7 ± 8.0. Graft survival censored for death at 5 years was of 77%. Using a multivariate analysis by Cox model, the only predictor of graft loss present in the donor was IRF before organ procurement (HR 4.2 CI95[1.8–9.7]). IRF was also associated with significant lower estimated glomerular filtration rates up to 1 year post-transplantation. By contrast, KDPI score (median of 98 [96–100]), was not associated with the risk of graft failure. Then, IRF before kidney procurement may define a risk subgroup among very-old deceased kidney donors, in whom pre-implantatory biopsies, dual kidney transplantation or calcineurin inhibitor-free immunosuppressive regimen could help to improve outcomes.

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Section: Discussionsupporting

confidence: 91%

“…Several studies have reported the outcomes of renal transplant recipients who received a kidney from a deceased donor older than 70 years (Table 6) [13][14][15][16][17][18][19][20] . However, none of these studies have analyzed the impact of donor IRF before kidney procurement.…”

Section: Discussionmentioning

confidence: 99%

Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors

Maanaoui

François

Bouyé

et al. 2021

Sci Rep

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“…O benefício em termos de sobrevivência deste tipo de transplante em doentes mais velhos quando comparados com os doentes que permanecem em diálise existe e pode ser aproveitado. 26,27 Tendo isto em conta, o modelo de cores aqui proposto impõe que dadores de maior idade sejam dirigidos a candidatos mais idosos, no entanto não encontramos diferenças estatisticamente significativas entre as idades dos candidatos selecionados com o modelo 1 e os candidatos selecionados com o modelo 3.…”

Section: Discussionunclassified

Seleção do Par Dador-Recetor em Transplante Renal: Resultados Comparativos de uma Simulação

Lima

Alves

2017

Acta Med Port

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“…По мере накопления опыта по системе "old-toold" и разработки более четких критериев отбора реципиентов и оценки качества трансплантата результаты таких трансплантаций существенно улучшились и оказались сопоставимыми со статистикой трансплантаций при пересадке почки от стандартных доноров [23,24]. Обобщенный анализ результатов более чем за 10 лет показал, что если в начале использования программы 5-летняя выживаемость трансплантатов составляла около 50%, то к 2009 г. она увеличилась до 76,2% [25].…”

Section: трансплантация почки по системе "Old-to-old"unclassified

“…Разработан прогностический показатель качества почечного трансплантата, изъятого у неоптимального донора, включающий в себя такие параметры, как возраст донора, наличие артериальной гипертонии, избыточная масса тела, длительное пребывание в стационаре до констатации смерти и использование адреналина в ходе реанимационных мероприятий [11]. По данным S. Machado et al [24], риск ранней утраты трансплантата при возрасте донора старше 60 лет возрастает в 1,9 раза по сравнению с ТП от более молодых доноров, а при наличии у донора артериальной гипертонии он возрастает в 2,16 раза. Схожая ситуация возникает при увеличении концентрации креатинина крови донора старше 60 лет выше 1,5 мг/дл: риск ранней утраты трансплантата возрастает в 2,36 раза.…”

Section: критерии оценки качества трансплантата и возможности трансплантации почек со сниженными функциональными резервамиunclassified

Current possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological history

Khubutiya¹,

Rzhevskaya²,

Лисенок³

2021

Transplantologiâ (Mosk.)

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Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.

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Kidney Transplantation Using Donors Over 70 Years Old: Are the Criteria for Organ Allocation Too Expanded?

Cited by 13 publications

References 11 publications

Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors

Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors

Seleção do Par Dador-Recetor em Transplante Renal: Resultados Comparativos de uma Simulação

Current possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological history

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