The Evolution of Living Kidney Donation and Transplantation in Older Adults

Rowe, Theresa; Huded, Jill M.; McElroy, Lisa M.; Ladner, Daniela P.; Lindquist, Lee A.

doi:10.1111/jgs.13832

Cited by 7 publications

(3 citation statements)

References 30 publications

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“…The difference in the practice of utilizing living kidney donors between Europe and the USA is well‐known . Although still relatively small, the number of living donor kidney transplants in patients >65 years in the USA has been slowly increasing . In our study, the number of kidney grafts from living donors transplanted into older adult patients appeared to decrease.…”

Section: Discussionmentioning

confidence: 52%

Access to kidney transplantation in European adults aged 75-84 years and related outcomes: an analysis of the European Renal Association-European Dialysis and Transplant Association Registry

et al. 2018

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To what extent access to, and allocation of kidney transplants and survival outcomes in patients aged ≥75 years have changed over time in Europe is unclear. We included patients aged ≥75-84 years (termed older adults) receiving renal replacement therapy in thirteen European countries between 2005 and 2014. Country differences and time trends in access to, and allocation of kidney transplants were examined. Survival outcomes were determined by Cox regression analyses. Between 2005 and 2014, 1392 older adult patients received 1406 transplants. Access to kidney transplantation varied from ~0% (Slovenia, Greece and Denmark) to ~4% (Norway and various Spanish regions) of all older adult dialysis patients, and overall increased from 0.3% (2005) to 0.9% (2014). Allocation of kidney transplants to older adults overall increased from 0.8% (2005) to 3.2% (2014). Seven-year unadjusted patient and graft survival probabilities were 49.1% (95% confidence interval, 95% CI: 43.6; 54.4) and 41.7% (95% CI: 36.5; 46.8), respectively, with a temporal trend towards improved survival outcomes. In conclusion, in the European dialysis population aged ≥75-84 years access to kidney transplantation is low, and allocation of kidney transplants remains a rare event. Though both are increasing with time and vary considerably between countries. The trend towards improved survival outcomes is encouraging. This information can aid informed decision-making regarding treatment options.

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Section: Discussionmentioning

confidence: 52%

Access to kidney transplantation in European adults aged 75-84 years and related outcomes: an analysis of the European Renal Association-European Dialysis and Transplant Association Registry

et al. 2018

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“…Deceased donors are frequently older than living donors; nevertheless, it has been shown that survival rates of living donor organs are better in every age category, compared to BD's organs. 2 What is more, average HLA matching is usually worse in living donation.…”

Section: Discussionmentioning

confidence: 99%

Brain death-associated pathological events and therapeutic options

Chudoba¹,

Krajewski²,

Wojciechowska³

et al. 2017

Adv Clin Exp Med

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“…As the kidney recipient pool ages, it is increasingly common to find living kidney donors who are the adult offspring of recipients (1). A recent publication in the American Journal of Transplantation by Cohen et al reported that recipients of offspring donors had higher mortality and graft loss (2).…”

Section: Introductionmentioning

confidence: 99%

Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States

Holscher

Luo

Massie

et al. 2019

American Journal of Transplantation

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A recent study reported that kidney transplant recipients of offspring living donors had higher graft loss and mortality. This seemed counterintuitive, given the excellent HLA matching and younger age of offspring donors; we were concerned about residual confounding and other study design issues. We used SRTR data 2001–2016 to evaluate death-censored graft failure (DCGF) and mortality for recipients of offspring versus non-offspring living donor kidneys, using Cox regression models with interaction terms. Recipients of offspring kidneys had lower DCGF than recipients of non-offspring kidneys (15-year cumulative incidence 21.2% vs 26.1%, p<0.001). This association remained after adjustment for recipient and transplant factors (aHR=0.73 0.77 0.82, p<0.001), and was attenuated among African American donors (aHR 0.77 0.85 0.95; interaction: p=0.01) and female recipients (aHR 0.77 0.84 0.91, p<0.001). Although offspring kidney recipients had higher mortality (15-year mortality 56.4% vs 37.2%, p<0.001), this largely disappeared with adjustment for recipient age alone (aHR=1.02 1.06 1.10, p=0.002) and was non-significant after further adjustment for other recipient characteristics (aHR=0.93 0.97 1.01, p=0.1). Kidneys from offspring donors provided lower graft failure and comparable mortality. An otherwise eligible donor should not be dismissed because they are the offspring of the recipient, and we encourage continued individualized counseling for potential donors.

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The Evolution of Living Kidney Donation and Transplantation in Older Adults

Cited by 7 publications

References 30 publications

Access to kidney transplantation in European adults aged 75-84 years and related outcomes: an analysis of the European Renal Association-European Dialysis and Transplant Association Registry

Access to kidney transplantation in European adults aged 75-84 years and related outcomes: an analysis of the European Renal Association-European Dialysis and Transplant Association Registry

Brain death-associated pathological events and therapeutic options

Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States

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