Negative impact of 'old-to-old' donations on success of cadaveric renal transplants

Area of Science:

• Nephrology
• Transplantation Surgery
• Geriatric Medicine

Background:

• Cadaveric renal transplantation is a vital treatment for end-stage renal disease.
• Donor scarcity often leads to considering all available organs, including those from older donors for older recipients.
• The outcomes of 'old-to-old' donor-recipient age combinations require specific evaluation.

Purpose of the Study:

• To evaluate the impact of 'old-to-old' donor and recipient age matching on cadaveric renal transplant outcomes.
• To assess the association between 'old-to-old' transplants and operative complications.
• To determine graft survival rates in 'old-to-old' renal transplant recipients.

Main Methods:

• Retrospective analysis of 325 solitary cadaveric renal transplantations in Israel over a 3-year period.
• Data abstraction from patient charts, including preoperative information and hospital course.
• Statistical analysis using Kaplan-Meier survival curves and univariate/multivariate Cox models.

Main Results:

• Overall 1-year graft failure rate was 19.1%.
• 'Old-to-old' transplants exhibited a significantly higher failure rate (46.2%) compared to other age combinations (15.5%, p < 0.0001).
• 'Old-to-old' transplants were independently associated with increased graft failure and operative complications.

Conclusions:

• The 'old-to-old' donor-recipient strategy in cadaveric renal transplantation is associated with significantly worse graft survival and higher operative complication rates.
• These findings suggest that the practice of utilizing 'old-to-old' transplants, even amid donor shortages, warrants critical re-evaluation.
• Further research may be needed to optimize donor selection criteria for renal transplantation.