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Use of marginal organs from non-heart-beating cadaveric kidney donors
K Mizutani1, Y Ono, T Kinukawa
1Department of Urology, Nagoya University School of Medicine, Japan.
Background:
The severe shortage of cadaver donor kidneys for transplantation has prompted many centers to utilize older donor kidneys, which have been associated with lower graft survival rates. The aim of the present study was to examine the availability and feasibility of considering kidneys from donors over the age of 60.
Method:
We studied 252 cadaveric renal transplant recipients (156 males, 96 females) who received kidneys from uncontrolled non-heart-beating donors between 1987 and 1997. We performed in situ cooling with especially designed double-balloon catheters to minimize warm ischemic kidney damage. Recipients were classified according to donor age (
Results:
Graft survival rates for recipients of kidneys from the older donor group at 1, 5, and 10 years after transplantation were 77%, 37%, and 30%, respectively. Corresponding values for the younger donor kidney recipients were 87%, 64%, and 47%, respectively (P=0.0011). Improved survival rates were noted when older kidneys were used for lighter weight recipients (<54 kg). No other significant factors impacted on older donor graft survival rates.
Conclusion:
Older donor kidneys are associated with poorer graft survival rates. However, kidney transplants from older donors can be quite effective in lighter weight recipients (<54 kg).
Insights
Kidneys from donors over 60 have lower graft survival rates in kidney transplants. However, these older donor kidneys can be effective for lighter weight recipients, offering a viable option in donor shortages.
Area of Science:
- Nephrology
- Transplantation Immunology
- Organ Donation
Background:
- The critical shortage of cadaver donor kidneys for transplantation necessitates exploring alternative donor sources.
- Utilizing kidneys from older donors (over 60) is a strategy to address this shortage, but is associated with reduced graft survival rates.
Purpose of the Study:
- To evaluate the availability and feasibility of using kidneys from donors aged over 60 for renal transplantation.
- To compare graft survival rates between recipients of younger donor kidneys and older donor kidneys.
Main Methods:
- A cohort of 252 cadaveric renal transplant recipients receiving kidneys from uncontrolled non-heart-beating donors (1987-1997) were analyzed.
- Donors were categorized by age (<60 and >60 years), and in situ cooling with double-balloon catheters was employed to minimize ischemic injury.
- Graft survival rates were assessed at 1, 5, and 10 years post-transplantation, with a minimum 1-year follow-up.
Main Results:
- Graft survival rates for older donor kidneys were significantly lower than for younger donor kidneys at all time points (1, 5, and 10 years).
- Specifically, 10-year graft survival was 30% for older donors versus 47% for younger donors (P=0.0011).
- A notable finding was improved survival rates when older donor kidneys were transplanted into lighter weight recipients (<54 kg).
Conclusions:
- Kidneys from donors over 60 are associated with poorer long-term graft survival outcomes in renal transplantation.
- Despite lower overall survival, older donor kidneys can be a feasible and effective option for lighter weight recipients, mitigating donor organ scarcity.