Abstract
Background: Despite a significant shortage of kidneys for transplantation in the US, kidneys from older deceased donors are infrequently transplanted. This is primarily over concern of graft quality and transplant durability. Methods: The US national transplant database (2000–2018) was assessed for deceased donor kidney transplant patient and graft survival, graft durability and stratified by donor age (<65 years>), Kidney Donor Profile Index (KDPI) and estimated glomerual filtration rate (GFR) one year post-transplantation (eGFR-1) were calculated. Findings: Recipients of kidneys transplanted from deceased donors >65 years had a lower eGFR-1, (median 39 ml/min) than recipients of younger donor kidneys (median 54 ml/min). However, death-censored graft survival, stratified by eGFR-1, demonstrated similar survival, irrespective of donor age or KDPI. The durability of kidney survival decreases as the achieved eGFR-1 declines. KDPI has a poor association with eGFR-1 and lesser for graft durability. While recipients of kidneys > 65 years had a higher one year mortality than younger kidney recipients, recipients of kidneys > 65 years and an eGFR-1 <30 ml/min, had a lower survival than an untransplanted waitlist cohort (p<0.001). Interpretation: The durability of kidney graft survival after transplantation was associated with the amount of kidney function gained through the transplant (eGFR-1) and the rate of graft loss (return to dialysis) was not significantly associated with donor age. 24.9% of recipients of older donor kidneys failed to achieve sufficient eGFR-1 providing a transplant survival benefit. While there is significant benefit from transplanting older kidneys, better decision-making tools are required to avoid transplanting kidneys that provide insufficient renal function. Funding: None.
| Original language | English (US) |
|---|---|
| Article number | 100980 |
| Journal | EClinicalMedicine |
| Volume | 37 |
| DOIs | |
| State | Published - Jul 2021 |
Bibliographical note
Funding Information:There was no outside funder for this analysis. The database is supported through a contract with HRSA. This study used the Organ Procurement and Transplantation Network (OPTN) database that includes information on donors, wait-listed candidates, and transplant recipients in the U.S. and has been described at https://optn.transplant.hrsa.gov/data/about-data/. The Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services provides oversight to the activities of the OPTN contractor. All data used in this study are publicly available from the OPTN. Processes to obtain the data are enunciated on the OPTN website, found here: https://optn.transplant.hrsa.gov/data/request-data/data-request-instructions/. TP and GV developed the initial hypothesis. GV and RC collected, organized and performed final statistical analysis of data. TP, GV, RC and DK analyzed data and generated conclusions. TP was primary author of manuscript and incorporated edits and suggestions from GV, RC and DK. There is agreement amongst all authors about the content and interpretation.
Publisher Copyright:
© 2021 The Author(s)
Keywords
- Age
- Donation
- Glomerular filtration rate (GFR)
- Outcomes
- Transplantation