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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

1
ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
2
Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
3
Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
4
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
5
Finnish Registry for Kidney Diseases, Helsinki, Finland.
6
Department of Medicine, Zealand University Hospital, Roskilde, Denmark.
7
Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
8
Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, Finland.
9
Unidad de Información sobre Pacientes Renales de la Comunidad Autónoma del País Vasco (UNIPAR), Basque Country, Spain.
10
Division of Nephrology, Ambroise Pare University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France.
11
Institut National de la Sante et de la Recherche Medicale (INSERM) U1018, Team 5, CESP UVSQ, University Paris Saclay, Villejuif, France.

Abstract

Background:

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

Methods:

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.

Results:

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.

Conclusions:

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.

PMID:
30203080
DOI:
10.1093/ndt/gfy268

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