Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes

We evaluated risk factors that could adversely affect outcomes from elderly deceased-donor transplants.

In this single center retrospective study (112 patients), we studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.

Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years. Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%. Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years. Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome. Acute rejection episode was an independent predictor of graft outcome (β level = 2.857, t test = 2.3, P = .025). Donor age was a predictor of total graft survival duration (log-rank test gave chi-square test with 2 df = 12.292, P = .002). Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min (log-rank test gave chi-squared test with 1 df = 7.213, P = .007). Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes (hazard ratio 5.443; 95% confidence interval, 2.226-15.311; P < .001) and donor estimated glomerular filtration rate (hazard ratio 0.449; 95% confidence interval, 0.209-0.945; P = .035) remained significant predictors of cumulative graft survival.

The risk factors mentioned above should be avoided to achieve better graft survival. Emphasis should not be on donor age alone. Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.