Outcomes in Kidney Transplant Recipients From Older Living Donors

Englum, Brian R.; Schechter, Matthew A.; Irish, William; Ravindra, Kadiyala V.; Vikraman, Deepak; Sanoff, Scott; Ellis, Matthew J.; Sudan, Debra; Patel, Uptal D.

doi:10.1097/tp.0000000000000607

Cited by 56 publications

(38 citation statements)

References 16 publications

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“…Routine use of older living donors is increasing in clinical practice and organs from older donors have been repeatedly shown to have worse outcomes in LDKT but remains comparatively better than standard, young deceased donor organs (19). In particular, DGF rates above 5% are seen with donors above the age of 60, which is well above the recent overall DGF rate of 2.75% for LDKT reported in the SRTR Annual report (20).…”

Section: Discussionmentioning

confidence: 99%

Shipping living donor kidneys and transplant recipient outcomes

Treat

Chow

Peipert

et al. 2018

American Journal of Transplantation

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Kidney paired donation (KPD) is an important tool to facilitate living donor kidney transplantation (LDKT). Concerns remain over prolonged cold ischemia times (CIT) associated with shipping kidneys long distances through KPD. We examined the association between CIT and delayed graft function (DGF), allograft survival, and patient survival for 1267 shipped and 205 nonshipped/internal KPD LDKTs facilitated by the National Kidney Registry in the United States from 2008 to 2015, compared to 4800 unrelated, nonshipped, non-KPD LDKTs. Shipped KPD recipients had a median CIT of 9.3 hours (range = 0.25-23.9 hours), compared to 1.0 hour for internal KPD transplants and 0.93 hours for non-KPD LDKTs. Each hour of CIT was associated with a 5% increased odds of DGF (adjusted odds ratio: 1.05, 95% confidence interval [CI], 1.02-1.09, P < .01). However, there was not a significant association between CIT and all-cause graft failure (adjusted hazard ratio [aHR]: 1.01, 95% CI: 0.98-1.04, P = .4), death-censored graft failure ( [aHR]: 1.02, 95% CI, 0.98-1.06, P = .4), or mortality (aHR 1.00, 95% CI, 0.96-1.04, P > .9). This study of KPD-facilitated LDKTs found no evidence that long CIT is a concern for reduced graft or patient survival. Studies with longer follow-up are needed to refine our understanding of the safety of shipping donor kidneys through KPD.

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Section: Discussionmentioning

confidence: 99%

Shipping living donor kidneys and transplant recipient outcomes

Treat

Chow

Peipert

et al. 2018

American Journal of Transplantation

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“…11,12 Studies have shown kidneys from >60-years-old donors to have donors. 11,12 Studies have shown kidneys from >60-years-old donors to have donors.…”

Section: Discussionmentioning

confidence: 99%

“…Expectedly, attrition was significant in the >65-years-old cohort long-term. (7) Proteinuria 54 (14) 76 (6) Hyperlipidemia 53 (11) 73 (7) ESRD 56 (11) 84 (4) TA B L E 2 (Continued) (7) Proteinuria 54 (14) 76 (6) Hyperlipidemia 53 (11) 73 (7) ESRD 56 (11) 84 (4) TA B L E 2 (Continued)…”

Section: Characteristics Of Donors >65-years-oldmentioning

confidence: 99%

Age alone is not a contraindication to kidney donation: Outcomes of donor nephrectomy in the elderly

Serrano

Yadav

Bangdiwala

et al. 2018

Clinical Transplantation

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With increasing organ demand, living kidney donation from older donors (>60-years-old) has become more common. Between 1975 and 2014, 3752 donor nephrectomies (DN) were performed at University of Minnesota; 167 (4.5%) were >60-years-old Short- and long-term outcomes were compared between contemporaneous >60-years-old and <60-years-old donors. On univariate analysis, >60-years-old were more likely to have had prior abdominal surgery and hypertension; and less likely to smoke. Baseline estimated glomerular filtration rate (eGFR) was lower in >60-years-old (80 ± 16 vs 101 ± 26 mL/min/1.73 m ; P < .001). Intraoperative and postoperative complications were similar, except a higher prevalence of <30 day ileus (3% vs 7%; P = .021) and longer postoperative length of stay (LOS) (4.2 vs 4.6 days; P = .005). On multivariate analysis, <30 day ileus and LOS continued to be significantly greater for >60-years-old After >20 years post-DN, systolic blood pressure was significantly higher among >60-years-old (142 vs 125 mm Hg; P < .001) and HTN was diagnosed earlier (9 vs 14 years). After donation, eGFR was significantly lower for >60-years-old but slope of eGFR and rates of end-stage renal disease (ESRD) were not significantly different >20 years post-DN. Thus, kidney donation among carefully selected >60-years-old poses minimal perioperative risks and no added risk of long-term ESRD.

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“…An alternative would be to pursue living donor transplantation from older donors such as their spouses or peers. Several studies have shown that recipients of kidneys from older living donors have reasonable outcomes[41-43]. Englum et al[41] studied 250827 patients based on UNOS data who received a kidney transplant, of which 92646 were LD kidneys and 4186 from donors aged ≥ 60 years.…”

Section: Which Type Of Kidney Is Best?mentioning

confidence: 99%

“…Several studies have shown that recipients of kidneys from older living donors have reasonable outcomes[41-43]. Englum et al[41] studied 250827 patients based on UNOS data who received a kidney transplant, of which 92646 were LD kidneys and 4186 from donors aged ≥ 60 years. Not surprisingly, graft and patient survivals of patients who received a kidney from an older LD were worse compared to those who received a kidney from a younger LD.…”

Section: Which Type Of Kidney Is Best?mentioning

confidence: 99%

Older candidates for kidney transplantation: Who to refer and what to expect?

Concepcion¹,

Forbes²,

Schaefer³

2016

WJT

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The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systems-based medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new Kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.

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Outcomes in Kidney Transplant Recipients From Older Living Donors

Cited by 56 publications

References 16 publications

Shipping living donor kidneys and transplant recipient outcomes

Shipping living donor kidneys and transplant recipient outcomes

Age alone is not a contraindication to kidney donation: Outcomes of donor nephrectomy in the elderly

Older candidates for kidney transplantation: Who to refer and what to expect?

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