Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

Fritsche, Lutz; Hörstrup, Jan; Budde, Klemens; Reinke, Petra; Giessing, Markus; Tullius, Stefan G.; Loening, Stefan A.; Neuhaus, P.; Neumayer, Hans‐Hellmut; Frei, Ulrich

doi:10.1046/j.1600-6135.2003.00251.x

Cited by 115 publications

(79 citation statements)

References 15 publications

(13 reference statements)

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“…A similar model, aimed at increasing the utilization of older donors and reducing waiting time for older recipients, is already being used in the voluntary Eurotransplant Senior Program (23). Early results indicated that the program had potential to meet these goals, particularly in conjunction with reduced cold ischemic time (24).…”

Section: Discussionmentioning

confidence: 99%

“…However, black patients, who have decreased mortality rates on dialysis, seem to have increased benefit when they are selective regarding organ quality. Despite this, black patients historically have listed more frequently for and received lower quality deceased donor organs relative to white patients (24). Certainly, in addition to life expectancy calculations, patient affinity for dialysis and quality of life are important considerations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Which Renal Transplant Candidates Should Accept Marginal Kidneys in Exchange for a Shorter Waiting Time on Dialysis?

Schold

Meier-Kriesche

2006

Clinical Journal of the American Society of Nephrology

176

126

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Renal transplantation has been established as a life-saving procedure for patients with ESRD. Deceased donor kidneys convey variable life expectancies for recipients. However, limited information is available to guide patients and patient advocates concerning the appropriateness to list for expanded criteria donations (ECD). Half-lives for wait-listed transplant candidates were estimated from the time of ESRD onset on the basis of recipient age, primary diagnosis, and organ quality using survival models. In addition, we evaluated the likelihood of candidates' receiving a transplant on the basis of age and other characteristics by duration of waiting time. Older patients (65؉) had longer life expectancy when they accepted an ECD within 2 yr of ESRD onset (5.6 yr) compared with waiting for a standard kidney (5.3 yr) or a living donation (5.5 yr) after 4 yr of dialysis. Conversely, younger recipients (18 to 39 yr) had longer life expectancy with a living donation (27.6 yr) or standard kidney (26.4 yr) after 4 yr on dialysis compared with an ECD after 2 yr of dialysis (17.6 yr). Increased candidate age was associated with the likelihood of not receiving a transplant during the period on the waiting list as a result of mortality and separately related to morbidity and delisting. Older and frailer transplant candidates benefit from accepting lower quality organs early after ESRD, whereas younger and healthier patients benefit from receiving higher quality organs even with longer dialysis exposure. These findings are important for transplant candidates and advocates decision-making and for potential further implementation in allocation policy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Which Renal Transplant Candidates Should Accept Marginal Kidneys in Exchange for a Shorter Waiting Time on Dialysis?

Schold

Meier-Kriesche

2006

Clinical Journal of the American Society of Nephrology

176

126

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“…However, there is controversy regarding the outcomes with older kidneys. 7,15,16 Donor age was significantly higher in our older recipients. We analyzed the outcome of our elderly patients according to donor's age and failed to observe a significant difference in actuarial patient and graft survivals when comparing older recipients of kidneys from an aging donor.…”

Section: Discussionmentioning

confidence: 67%

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Pedroso

Martins

Fonseca

et al. 2006

Transplantation Proceedings

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The prevalence of end-stage renal disease (ESRD) increases with advancing age. In most countries renal transplant recipients are getting older, too. Transplantation must be considered for ESRD patients older than 60 years; however, there are few data regarding outcomes in this population. We retrospectively reviewed the clinical course of recipients aged Ն60 years (n ϭ 43) who underwent primary or repeated grafts from August 1988 to December 2004. We then compared recipient and donor characteristics as well as graft and patient survivals with recipients aged 18 to 59 years (n ϭ 1058) who were transplanted during the same time. Donor age tended to be higher among the oldest recipient group (P Ͻ .001). Mean follow-up was significantly shorter in the group aged Ն60 years (P Ͻ .001), as our institution only recently has frequently accepted patients Ն60 years. Older recipients showed more frequent delayed graft function (P ϭ .007), longer initial hospitalization (P ϭ .005), and a significantly lower incidence of posttransplant acute rejection episodes (P ϭ .015). Patient (P ϭ .057), graft (P ϭ .407), and death-censored graft (P ϭ .649) survivals were not different between the two groups. Seven recipients aged Ն60 years died; the main cause of which was cardiovascular in origin. The loss of organs (n ϭ 11) in the older patients was mainly due to death with a functioning kidney (54.5%). Our results confirm that renal transplant must be considered in selected patients older than 60 years as patient and graft survivals are similar to those of younger patients. E LDERLY PATIENTS are the fastest growing population in dialysis programs. 1 Hemodialysis is the more commonly used modality, although it is associated with significant morbidity, mortality, and a poor quality of life. The prevalence of end-stage renal disease (ESRD) increases with advancing age. In most countries, renal transplant recipients are also getting older. In the precyclosporine era the unsatisfactory results of grafting in the elderly lead to the exclusion of patients more than 60 years of age due to higher risks for patient death and graft loss. 2 With widespread use of calcineurin inhibitors, the age limit for transplantation has expanded. Today, transplantation is considered the best treatment option for ESRD patients regardless of age when compared with dialysis. [3][4][5] With the development of new immunosuppressive alternatives, transplantation is safe and successful. It should be considered an alternative to dialysis even among older patients. Older ESRD patient survival after transplantation is higher than on the waiting list. [3][4][5] However, the organ donor shortage makes clinicians reluctant to transplant kidneys into older patients. Controversy has emerged regarding the appropriateness of transplantation in this patient group with a shortened life expectancy. Numerous studies have reported worse patient and graft survivals in older patients compared with younger patients, while other analyses did not find any difference. 6 -9 The...

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“…Donor HLA-typing is not required, so allocation is done by using only ABO group matching, negative crossmatch,and a local allocation based on waiting time in order to keep cold ischemia time to a minimum. In the preliminary report by Fritsche et al [74], this policy allowed the expansion of the donor and recipient pools without significantly affecting patient and graft survival. Anyway an increase in rate of acute rejections due to a higher number of HLA mismatches causing longer hospitalization and a major risk of graft loss was recorded.…”

Section: Strategy To Optimize the Outcome Of Marginal Donors And Kidnmentioning

confidence: 99%

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

Rosa

Muscogiuri

Sarno

2013

ISRN Transplantation

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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.

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Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

Cited by 115 publications

References 15 publications

Which Renal Transplant Candidates Should Accept Marginal Kidneys in Exchange for a Shorter Waiting Time on Dialysis?

Which Renal Transplant Candidates Should Accept Marginal Kidneys in Exchange for a Shorter Waiting Time on Dialysis?

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

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

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