Outcomes of Deceased Donor Kidney Transplantation in the Eurotransplant Senior Program with A Focus on Recipients ≥75 Years

Abstract

To evaluate the outcomes of kidney transplantations (KTs) in the Eurotransplant Senior Program (ESP) with a focus on the very old, defined as recipients ≥75 years. This retrospective clinical study included 85 patients, who under the ESP protocol underwent deceased donor kidney transplantation from January 2010 to July 2018 at the Charité–Universitätsmedizin Berlin in Germany. Recipients were divided in three age groups, i.e., Group 65–69, Group 70–74, Group ≥75, and compared. Prognostic risk factors for short and long-term outcomes of kidney transplantations were investigated. Graft survival at 1 and 5 years were respectively 90.7% and 68.0% for group 65–69, 88.9% and 76.2% for Group 70–74, and 100% and 71.4% for Group ≥75. Patient survival at 1 and 5 years were respectively 92.9% and 68.0% for Group 65–69, 85.7% and 61.5% for Group 70–74 and 100% and 62.5% for Group ≥75. Serum creatinine did not significantly differ between the three groups, with the exception of serum creatinine at 1 year. Increased recipient age and prolonged time on dialysis correlated with increased occurrence of postoperative complication. An increase in BMI, pretransplant diabetes mellitus and prolonged time on dialysis correlated with the occurrence of delayed graft function (DGF). History of smoking was identified as an independent risk factor for events of rejection. Increased human leukocyte antigen mismatches (HLA-MM) and prolonged cold ischemia time (CIT) correlated with higher rates of intensive care unit (ICU) treatment. This study supports kidney transplantations for the very old. End-stage renal disease (ESRD) patients ≥75 years of age who underwent kidney transplantation experienced comparable results to their younger counterparts. A comprehensive evaluation of ESRD patients with consideration of prognostic risk factor is the most suitable mean of identifying adequate kidney transplant candidates.

Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?

“…Kidney transplantation (KT) represents the "Gold-Standard" of treatment for patients with end-stage renal disease (ESRD) [1][2][3][4][5]. Ideally, a pre-emptive strategy should be adopted to ensure the best results [6][7][8][9].…”

Progress and Recent Advances in Solid Organ Transplantation

“…In this Special Issue, "Progress and Recent Advances in Solid Organ Transplantation", researchers from different disciplines with different expertise and resources highlighted the novelty of their recent investigations in the field of organ transplantation, including issues related to donors, allografts, and patient survival [8][9][10][11][12][13][14][15][16][17][18][19][20]. While there have been significant advances in regional and national kidney paired-donation programs in matching incompatible pairs, data suggest that there may be a role for desensitization in select cases to facilitate organ transplantation [21].…”

“…Better understanding of subgroups of transplant recipients, such as older transplant recipients and Black transplant recipients, can help the transplant community to identify individualized strategies to improve outcomes among these vulnerable populations [11,14,28]. In this Special Issue, Zompolas et al conducted a retrospective study to evaluate outcomes of 85 kidney transplant recipients aged ≥ 75 years in the Eurotransplant Senior Program from January 2010 to July 2018 at the Charité-Universitätsmedizin Berlin in Germany [11].…”

“…Better understanding of subgroups of transplant recipients, such as older transplant recipients and Black transplant recipients, can help the transplant community to identify individualized strategies to improve outcomes among these vulnerable populations [11,14,28]. In this Special Issue, Zompolas et al conducted a retrospective study to evaluate outcomes of 85 kidney transplant recipients aged ≥ 75 years in the Eurotransplant Senior Program from January 2010 to July 2018 at the Charité-Universitätsmedizin Berlin in Germany [11]. The investigators demonstrated comparable outcomes among older patients compared to their younger counterparts [11], confirming excellent outcomes, including in patient and graft survival, in carefully selected older kidney transplant recipients aged ≥ 75 years [29][30][31].…”

“…In this Special Issue, Zompolas et al conducted a retrospective study to evaluate outcomes of 85 kidney transplant recipients aged ≥ 75 years in the Eurotransplant Senior Program from January 2010 to July 2018 at the Charité-Universitätsmedizin Berlin in Germany [11]. The investigators demonstrated comparable outcomes among older patients compared to their younger counterparts [11], confirming excellent outcomes, including in patient and graft survival, in carefully selected older kidney transplant recipients aged ≥ 75 years [29][30][31]. Lastly, in this Special Issue, we reported outcomes of kidney transplant recipients with sickle cell disease (SCD) from an analysis of the 2000-2019 United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network Database [14].…”