The advanced age deceased kidney donor: Current outcomes and future opportunities

The advanced age deceased kidney donor: Current outcomes and future opportunities.BackgroundDue to the aging general population, deceased donors ≥55 years will form an increasingly larger proportion of the deceased kidney donor pool.MethodsUsing data from the United States Renal Data System, we determined the change in graft survival between 1996 and 2000 among 32,557 recipients of donors aged <55 years and ≥55 years in univariate and multivariate survival analyses. We identified donor risk factors for graft loss that might influence the decision to accept or reject donors <55 and ≥55 years. The initial glomerular filtration rate established 6 months after transplantation (initial GFR), and the stability of GFR in the first post-transplant year (GFR at 12 months post-transplantation—GFR at six months post-transplantation) were compared between recipients of donors <55 and ≥55 years and the association of these factors with graft survival was determined.ResultsIn 2000, one-year graft survival in donors ≥55 years was 86.7%. Between 1996 and 1999 the projected graft half life improved from 11.4 to 14.5 years for recipients of donors <55 years (P < 0.01); however, there was no improvement for recipients of donors ≥55 years (8.2 to 9.2 year, P = 0.46). Among donor factors studied, only cold ischemic time >24 hours identified recipients of donors ≥55 years at risk for graft loss. Compared to recipients of donors <55 years, recipients of donors ≥55 years established a lower initial GFR (42 vs. 56 mL/min/1.73m2, P < 0.0001), and had less stable GFR in the first post-transplant year (-1.5 vs. -0.6 mL/min/1.73m2, P <.0001). Recipients from donors ≥55 years with initial GFR ≥50 mL/min/1.73m2 and no drop GFR during the first post-transplant year had graft survival that was superior to that of donors <55 years with either initial GFR <50 mL/min/1.73m2 or a drop in GFR during the first post-transplant year.ConclusionDonors ≥55 years are a valuable resource. Despite improvements in immunosuppression, rejection, and delayed graft function, the projected increase in long-term graft survival among recipients of donors <55 years was not shared among recipients of donors ≥55 years. Recipients of donors ≥55 years had lower initial GFR, and less stable GFR during the first post-transplant year. Limiting cold ischemic time to <24 hours may improve outcomes among recipients of donors ≥55 years. Future studies to maximize initial GFR and minimize early loss of GFR in recipients of donors ≥55 years may lead to improved outcomes from deceased donors ≥55 years.