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Transplantation. 2014 Nov 27;98(10):1069-76. doi: 10.1097/TP.0000000000000181.

The combined risk of donor quality and recipient age: higher-quality kidneys may not always improve patient and graft survival.

Author information

1
1 Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. 2 Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 3 Division of Transplant Surgery, Brigham and Women's Hospital, Boston, MA. 4 Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA. 5 Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT. 6 Address correspondence to: Stefan G. Tullius, M.D., Ph.D., Division of Transplant Surgery, Brigham and Women's Hospital, 75 Francis Street, PBB215, Boston, MA 02140.

Abstract

BACKGROUND:

The Kidney Donor Profile Index (KDPI) is a more precise donor organ quality metric replacing age-based characterization of donor risk. Little prior attention has been paid on the outcomes of lower-quality kidneys transplanted into elderly recipients. Although we have previously shown that immunological risks associated with older organs are attenuated by advanced recipient age, it remains unknown whether risks associated with lower-quality KDPI organs are similarly reduced in older recipients.

METHODS:

Donor organ quality as measured by the KDPI was divided into quintiles (very high, high, medium, low, and very low quality), and Cox proportional hazards was used to assess graft and recipient survival in first-time adult deceased donor transplant recipients by recipient age.

RESULTS:

In uncensored graft survival analysis, recipients older than 69 years had demonstrated comparable outcomes if they received low-quality kidneys compared to medium-quality kidneys. Death-censored analysis demonstrated no increased relative risk when low-quality kidneys were transplanted into recipients aged 70 to 79 years (hazard ratio [HR], 1.11; P=0.19) or older than 79 years (HR, 1.08; P=0.59). In overall survival analysis, elderly recipients gained no relative benefit from medium-quality kidneys over low-quality kidneys (70-79 years: HR, 1.03, P=0.51; >79 years: HR, 1.08; P=0.32).

CONCLUSION:

Our analysis demonstrates that transplanting medium-quality kidneys into elderly recipients does not provide significant advantage over low-quality kidneys.

PMID:
24918617
PMCID:
PMC4455544
DOI:
10.1097/TP.0000000000000181
[Indexed for MEDLINE]
Free PMC Article

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