"Suboptimal" kidney donors: the experience with tacrolimus-based immunosuppression

Area of Science:

• Nephrology
• Transplantation Immunology
• Geriatric Medicine

Background:

• Donor age and sex are critical factors influencing renal transplant outcomes.
• Previous studies suggest potential disparities in graft survival based on donor demographics.
• Tacrolimus-based immunosuppression is a standard protocol in renal transplantation.

Purpose of the Study:

• To evaluate the impact of donor age (pediatric vs. adult, and >60 years vs. <60 years) and sex (female vs. male) on renal transplant outcomes.
• To assess patient and graft survival rates and renal function in recipients of kidneys from these specific donor subgroups.
• To determine the efficacy of tacrolimus-based immunosuppression in mitigating risks associated with marginal donor organs.

Main Methods:

• Retrospective analysis of 397 renal transplant recipients on tacrolimus-based immunosuppression.
• Comparison of patient and graft survival rates at 1 and 3 years post-transplant.
• Assessment of renal function using serum creatinine levels.
• Subgroup analysis based on donor sex (female vs. male), donor age (pediatric en bloc vs. other cadaveric, and >60 years vs. <60 years).

Main Results:

• Female donors showed comparable patient and graft survival rates and renal function to male donors.
• Pediatric en bloc kidney recipients had comparable survival rates to other cadaveric kidney recipients, with better renal function.
• Donors over 60 years were associated with significantly worse patient and graft survival rates and poorer renal function compared to younger donors (<60 years).

Conclusions:

• Under tacrolimus immunosuppression, kidneys from female or pediatric donors do not lead to adverse outcomes.
• Organs from donors over 60 years of age are associated with inferior renal transplant outcomes.
• Donor age remains a significant factor, with older donors posing a higher risk for graft failure.