Outcome after renal transplantation in a "senior" program: the Croatian experience

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• The Eurotransplant "senior" program allocates deceased donor kidneys from elderly donors (>65 years) to patients over 65 to increase transplantation rates.
• This program prioritizes reduced cold ischemia time by omitting human leukocyte antigen (HLA) matching.
• Croatia implemented its own senior kidney transplant program incorporating HLA matching.

Purpose of the Study:

• To compare the outcomes of Croatia's HLA-matched senior kidney transplant program with the Eurotransplant program.

Main Methods:

• Prospective follow-up of all patients aged 65 years or older undergoing their first renal transplantation.
• Data collected included human leukocyte antigen (HLA) matching, cold ischemia time, renal function, complications, and hospitalization duration.
• Comparison of outcomes between Croatian and Eurotransplant senior kidney transplant programs.

Main Results:

• In Croatia's program, 22 elderly patients (mean age 67.4 years) received kidneys from donors >65 years old (mean age 66 years).
• One-year patient survival was 95.4% and graft survival was 81.8%, with 1-5 human leukocyte antigen (HLA) mismatches and 7-15 hours of cold ischemia time.
• High rates of delayed graft function (63.6%) and cardiovascular complications (40.9%) were observed, alongside prolonged hospitalizations (mean 45 days).

Conclusions:

• Croatia's senior kidney transplant program, incorporating human leukocyte antigen (HLA) matching, demonstrates comparable patient and graft survival rates to the Eurotransplant program.
• The study highlights significant challenges including delayed graft function, cardiovascular complications, and extended hospitalization in elderly kidney transplant recipients.
• Further research is needed to optimize outcomes for elderly kidney transplant recipients, balancing human leukocyte antigen (HLA) matching with cold ischemia time.