Old donors for kidney transplantation: how old?

Area of Science:

• Nephrology
• Transplant Surgery
• Pathology

Background:

• Increasing kidney transplant demand necessitates expanded donor criteria, including older donors.
• Older donor kidneys may have reduced nephron counts, potentially impacting graft survival due to recipient metabolic demand.
• Dual kidney transplantation is an option but doesn't always match single young donor graft outcomes.

Purpose of the Study:

• To develop and validate a pretransplant biopsy scoring system for optimizing the allocation of older donor kidneys.
• To compare outcomes of single versus dual kidney transplantation using older donor organs based on biopsy assessment.
• To determine if a biopsy-based allocation strategy can improve graft survival and expand donor criteria.

Main Methods:

• A panel of pathologists developed a scoring system for pretransplant kidney biopsies from older donors (age >60 years).
• Kidneys were allocated to single or dual transplantation based on this biopsy score.
• Graft survival rates were compared between different allocation strategies and donor age groups.

Main Results:

• Kidney graft survival using older donor kidneys (age >60) allocated via biopsy score was similar to single grafts from younger donors.
• This strategy yielded significantly better outcomes than single grafts from older donors without histological evaluation.
• Excellent outcomes were achieved even with kidneys from donors older than 70 years.

Conclusions:

• A pretransplant biopsy-based allocation algorithm for older donor kidneys can safely expand donor selection criteria.
• This approach increases the availability of kidney transplants while mitigating the risk of premature graft failure.
• Histological assessment of older donor kidneys is crucial for optimizing transplant outcomes.