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Nephrol Dial Transplant. 2018 Sep 7. doi: 10.1093/ndt/gfy268. [Epub ahead of print]

Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients ages 20-50 years: a study by the ERA-EDTA Registry.

Author information

ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Finnish Registry for Kidney Diseases, Helsinki, Finland.
Department of Medicine, Zealand University Hospital, Roskilde, Denmark.
Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.
Unidad de Información sobre Pacientes Renales de la Comunidad Autónoma del País Vasco (UNIPAR), Basque Country, Spain.
Division of Nephrology, Ambroise Pare University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France.
Institut National de la Sante et de la Recherche Medicale (INSERM) U1018, Team 5, CESP UVSQ, University Paris Saclay, Villejuif, France.



Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.


We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.


The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1-24.9]} and young [15.3% (95% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9-41.5)] and young [29.2% (95% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44-0.68)] and 40% [young aHR 0.60 (95% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00-1.04)] or 1% [young aHR 1.01 (95% CI 1.00-1.01)] increase in the 10-year risk of death.


Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.


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