Clinical EpidemiologyA Lifetime of Allograft Function with Kidneys from Older DonorsRose, Caren*; Schaeffner, Elke†; Frei, Ulrich†; Gill, Jagbir*,‡; Gill, John S.*,‡,§ Author Information *Division of Nephrology, University of British Columbia, Vancouver, Canada; †Division of Nephrology, Charité University Medicine, Berlin, Germany; ‡Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; and §Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts C.R. and E.S. contributed equally to this work. Correspondence: Dr. John S. Gill, University of British Columbia, St. Paul’s Hospital Providence Building Ward 6a, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Email: [email protected] Received August 12, 2014 Accepted December 4, 2014 Journal of the American Society of Nephrology 26(10):p 2483-2493, October 2015. | DOI: 10.1681/ASN.2014080771 Buy Metrics Abstract Strategies to increase expanded criteria donor (ECD) transplantation are needed. We quantified the extent to which ECD kidneys provide recipients with a lifetime of allograft function by determining the difference between patient survival and death-censored allograft survival (graft survival). Initial analyses compared 5-year outcomes in the Eurotransplant Senior Program (European) and the United States Renal Data System. Among European recipients ≥65 years, patient survival exceeded graft survival, and ECD recipients returned to dialysis for an average of 5.2 months after transplant failure. Among United States recipients ≥60 years, graft survival exceeded patient survival. Although patient survival in elderly recipients in the United States was low (49% at 5 years), the average difference in patient survival at 10 years in elderly recipients in the United States with an ECD versus non-ECD transplant was only 7 months. The probability of patient survival with a functioning allograft at 5 years was higher with ECD transplantation within 1 year after activation to the waiting list than with delayed non-ECD transplantation ≥3 years after activation to the waiting list. Subsequent analyses demonstrated that ECD transplants do not provide a lifetime of allograft function in recipients <50 years in the United States. These findings should encourage ECD transplantation in patients ≥60 years, demonstrate that rapid ECD transplantation is superior to delayed non-ECD transplantation, and challenge the policy in the United States of allowing patients <50 years to receive an ECD transplant. Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.