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Assessing the Limits in Kidney Transplantation

Use of Extremely Elderly Donors and Outcomes in Elderly Recipients

Arcos, Emma BSc†,a; Pérez-Sáez, María José MD, PhD†,b,c; Comas, Jordi BSca; Lloveras, Josepb; Tort, Jaume MDa; Pascual, Julio MD, PhDb,c on behalf of the Catalan Renal Registry

doi: 10.1097/TP.0000000000002748
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Background: Patient survival with end-stage renal disease is longer after kidney transplantation (KT) compared with remaining on dialysis. Nevertheless, this remains uncertain when receiving a kidney from a donor ≥80 years old.

Methods: In a longitudinal mortality study in the Catalan Renal Registry including 2,585 patients ≥60 years old on dialysis and placed on the KT waiting list, 1,084 received a first KT from a deceased donor aged 60-79 and 128 from a deceased donor ≥80. We calculated adjusted risk of graft loss by means of competing-risks regression, considering patient death with functioning graft as a competing event. To assess patient survival benefit from KT we calculated the adjusted risk of death by non-proportional-hazard analysis taking the fact of being transplanted as a time-dependent effect. Considering all KT ≥60 (n=1,212), we assessed whether the benefit of KT varied per different recipient characteristics by calculating the interaction effect between all potential mortality risk factors and the treatment group.

Results: Compared with kidneys from donors 60-79 years old, graft survival was significantly lower for kidneys ≥80, (SHR=1.55; 95% CI, 1.00 to 2.38; p=0.048). In comparison with those that remained on dialysis, adjusted risk of death 12 month after transplantation in recipients with a kidney ≥80y was 0.54 (95% CI, 0.38 to 0.77; p<0.0001).

Conclusions: Despite KT from octogenarian deceased donors being associated with reduced graft survival, recipients had lower mortality rates than those remaining on dialysis, even if the kidney came from an extremely aged donor.

aOrganització Catalana de Trasplantaments, Barcelona, Spain

bDepartment of Nephrology, Hospital del Mar, Barcelona, Spain

cInstitut Hospital del Mar d’Investigaciones Mèdiques, Barcelona, Spain

† Contributed equally

All authors revised the final version of the manuscript

Conflict of interest: The authors declare no conflict of interest.

Funding: This study was performed by the Renal Registry of Catalonia and collaborating professionals. The function of the Registry is to provide epidemiological data related to renal replacement therapy. No funding was received for this study and there are no potential conflicts of interest.

Corresponding author: Julio Pascual, MD, PhD, Department of Nephrology, Hospital del Mar. Passeig Maritim 25-29, 08003, Barcelona, Spain. Email: julpascual@gmail.com

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