Long-term outcome of renal transplantation from octogenarian donors: A multicenter controlled study

Piero Ruggenenti, Cristina Silvestre, Luigino Boschiero, Giovanni Rota, Lucrezia Furian, Annalisa Perna, Giuseppe Rossini, Giuseppe Remuzzi, Paolo Rigotti

Research output: Contribution to journalArticlepeer-review

Abstract

To assess whether biopsy-guided selection of kidneys from very old brain-dead donors enables more successful transplantations, the authors of this multicenter, observational study compared graft survival between 37 recipients of 1 or 2 histologically evaluated kidneys from donors older than 80 years and 198 reference-recipients of non-histologically evaluated single grafts from donors aged 60 years and younger (transplantation period: 2006-2013 at 3 Italian centers). During a median (interquartile range) of 25 (13-42) months, 2 recipients (5.4%) and 10 reference-recipients (5.1%) required dialysis (crude and donor age- and sex-adjusted hazard ratio [95% confidence interval] 1.55 [0.34-7.12], P = .576 and 1.41 [0.10-19.54], P = .798, respectively). Shared frailty analyses confirmed similar outcomes in a 1:2 propensity score study comparing recipients with 74 reference-recipients matched by center, year, donor, and recipient sex and age. Serum creatinine was similar across groups during 84-month follow-up. Recipients had remarkably shorter waiting times than did reference-recipients and matched reference-recipients (7.5 [4.0-19.5] vs 36 [19-56] and 40 [24-56] months, respectively, P < .0001 for both comparisons). Mean (± SD) kidney donor risk index was 2.57 ± 0.32 in recipients vs 1.09 ± 0.24 and 1.14 ± 0.24 in reference-recipients and matched reference-recipients (P < .0001 for both comparisons). Adverse events were similar across groups. Biopsy-guided allocation of kidneys from octogenarian donors permits further expansion of the donor organ pool and faster access to a kidney transplant, without increasing the risk of premature graft failure.

Original languageEnglish
Pages (from-to)3159-3171
JournalAmerican Journal of Transplantation
Volume17
Issue number12
DOIs
Publication statusPublished - 2017

Keywords

  • Clinical research/practice
  • Clinical trial
  • Donors and donation: donor evaluation
  • Graft survival
  • Kidney transplantation/nephrology
  • Organ allocation
  • Organ procurement
  • Organ procurement and allocation
  • Pathology/histopathology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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