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Observational Study
. 2021 Dec;34(12):2746-2754.
doi: 10.1111/tri.14130. Epub 2021 Oct 28.

Comparative survival of elderly renal transplant recipients with a living donor versus a deceased donor: A retrospective single center observational study

Erzsi Tegzess  1 , Antonio W Gomes Neto  1 , Robert A Pol  2 , Silke E de Boer  1 , Hessel Peters-Sengers  3 , Jan-Stephan F Sanders  1 , Stefan P Berger  1
Affiliations
Observational Study

Comparative survival of elderly renal transplant recipients with a living donor versus a deceased donor: A retrospective single center observational study

Erzsi Tegzess et al. Transpl Int. 2021 Dec.

Abstract

Increasing numbers of elderly (≥65 years) patients are listed for kidney transplantation. This study compares the survival outcome between living (LDK), regularly allocated (ETKAS), and Eurotransplant Senior Program (ESP) donor kidneys in elderly recipients. This is a single-center retrospective cohort study of elderly kidney transplant recipients transplanted between 2005 and 2017. Primary outcome measures were nondeath-censored graft, death-censored graft, and patient survival. In total, 348 patients were transplanted, 109 recipients (31.3%) received an LDK, 100 (28.7%) an ETKAS, and 139 (40%) an ESP kidney. 62.5% were male, and median age was 68 years. LDK recipients had significantly better 5-year nondeath-censored graft survival compared with ETKAS and ESP (resp. 71.0% vs. 66.1% vs. 55.6%, P = 0.047). Death-censored graft survival after 1 year was significantly better in LDK recipients (99.1%) (ETKAS 90.8%; ESP 87.7%, P < 0.001). After 5 years, the difference remained significant (P < 0.001) with little additional graft loss (97.7% vs. 88.1% vs. 85.6). There was no significant difference in patient survival after 5 years (71.7% vs. 67.4% vs 61.9%, P = 0.480). In elderly recipients, the patient survival benefits of an LDK are limited, but there is decreased death-censored graft loss for LDK recipients. Nevertheless, graft survival in ETKAS and ESP remains satisfactory.

Keywords: deceased donor; elderly patients; graft survival; kidney transplantation; living donor; patient survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study inclusion flow chart. LDK: Living donor kidney; ETKAS: Deceased donor allocated within Eurotransplant kidney allocation system; ESP: Deceased donor allocated within the Eurotransplant Senior Program.
Figure 2
Figure 2
Survival curves with patients at risk. (a) Graft survival (P = 0.047); (b) Death‐censored graft survival (P = 0.005); (c) Patient survival (P = 0.480).
Figure 3
Figure 3
eGFR per group. LDK: Living donor kidney; ETKAS: Deceased donor allocated within Eurotransplant kidney allocation system; and ESP: Deceased donor allocated within the Eurotransplant Senior Program.
See this image and copyright information in PMC

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