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Utilization of the older donor for renal transplantation
P C Kuo1, L B Johnson, E J Schweitzer
1Department of Surgery, University of Maryland Medical Systems, Baltimore, USA.
Insights
Kidney transplants from older donors (age > 60) show reduced graft survival, especially from cadaveric sources. Donor creatinine clearance, not age alone, is key for successful renal transplantation.
Area of Science:
- Nephrology
- Transplant Surgery
- Organ Donation
Background:
- Increasing organ shortages lead to using older kidney donors (> 60 years).
- Transplants from this donor group historically show lower graft survival rates.
Purpose of the Study:
- To evaluate graft survival in renal transplants using older donors (> 60 years).
- To identify factors influencing graft survival in older donor kidney transplants.
Main Methods:
- Retrospective review of 413 renal transplants (1991-1995).
- Comparison of older donor groups (cadaveric CT > 60, living donor LT > 60) with younger donor controls (CT < 50, LT < 50).
Main Results:
- One-year graft survival was significantly lower for older cadaveric donors (57.4%) compared to younger controls (89-100%) and older living donors (100%).
- Higher recipient serum creatinine and longer cold ischemia time were observed in the older cadaveric donor group.
- Donor creatinine clearance was the sole independent predictor of graft survival; clearance < 50 mL/minute predicted graft loss.
Conclusions:
- Donor age alone should not exclude kidneys for transplantation.
- Donor creatinine clearance is a critical factor in the decision algorithm for older renal donors.
Background:
The persistent shortage of ideal donor organs has resulted in increased transplantation of kidneys from older donors (age > 60 years). The overall experience with this donor subgroup indicates decreased graft survival.
Methods:
The records of 413 renal transplants performed between July 1991 and July 1995 were reviewed in a retrospective fashion to determine those patients who had received a cadaveric (CT > 60; n = 17) or living donor (LT > 60; n = 7) renal transplant from an older donor. Control groups consisted of randomly selected patients who received cadaveric (CT < 50; n = 20) or living related (LT < 50; n = 20) renal transplants from donors less than 50 years of age.
Results:
In the CT > 60 group, 1-year graft survival was 57.4%, significantly less than in those of the LT < 50 (100%), LT > 60 (100%), and CT < 50 (89%) groups. Mean recipient serum creatinine in the CT > 60 group was twofold greater than that of other groups at 1, 6, and 12 months following transplantation. Cold ischemia time and creatinine clearance correlated highly with graft survival. Stepwise regression analysis showed creatinine clearance to be the sole independent predictor of graft survival. A calculated donor creatinine clearance < 50 mL/minute was associated with ultimate graft loss.
Conclusion:
Age alone should not be an exclusion criterion to renal organ donation. When considering the older renal donor, creatinine clearance should be included within the decision algorithm.