Donor Characteristics Associated With Graft Loss and Delayed Graft Function in Very-Aged Kidney Donors: An...

This study explores the impact of using kidneys from very-aged donors to address the organ shortage, focusing on risk factors for graft loss and delayed graft function (DGF), independent of recipient factors. Data were sourced from the French multicentric prospective DIVAT cohort and retrospectively analyzed. The study included adult recipients transplanted between 2007 and 2018 receiving kidneys from brain-deceased donors over 70. The primary endpoint was death-censored graft survival, and secondary endpoint DGF. Among 1036 patients with a median follow-up of 3.96 years (2.01-6.31), donor hypertension (HR 1.46 95% CI (1.09-1.95), cold ischemia time (HR 1.03 per hour 95% CI (1.01-1.06) and HLA mismatches (after adjustment on DGF, HR 1.98 (1.45-2.71)) were significant risk factors for graft loss. Considering DGF, donor serum creatinine (HR 1.01 95% CI (1.01-1.01) per μmol/L), warm and cold ischemia times (HR 1.01 95% CI (1.0-1.01) per minute and HR 1.05 95% CI (1.02-1.08) per hour) and the use of SCOT preservation solution (HR 3.90 95% CI (1.26-11.84)) were deleterious, while hypothermic perfusion machine was protective (HR 0.65 95% CI (0.43-0.99)). The findings emphasize the paucity of modifiable variables associated with long-term outcomes in very-aged donors and the need for peri-transplant preservation strategies.