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. 2021 Nov 15;10(22):5308.
doi: 10.3390/jcm10225308.

Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

Renana Yemini  1   2 , Ruth Rahamimov  3   4 , Ronen Ghinea  4   5 , Eytan Mor  3   4
Affiliations

Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

Renana Yemini et al. J Clin Med. .

Abstract

With scarce organ supply, a selection of suitable elderly candidates for transplant is needed, as well as auditing the long-term outcomes after transplant. We conducted an observational cohort study among our patient cohort >60 years old with a long follow up. (1).

Patients and methods: We used our database to study the results after transplant for 593 patients >60 years old who underwent a transplant between 2000-2017. The outcome was compared between live donor (LD; n = 257) recipients, an old-to-old (OTO, n = 215) group using an extended criteria donor (ECD) kidney, and a young-to-old (YTO, n = 123) group using a standard-criteria donor. The Kaplan-Meir method was used to calculate the patient and graft survival and Cox regression analysis in order to find risk factors associated with death. (2).

Results: The 5- and 10-year patient survival was significantly better in the LD group (92.7% and 66.9%) compared with the OTO group (73.3% and 42.8%) and YTO group (70.9% and 40.6%) (p < 0.0001). The 5- and 10-year graft survival rates were 90.3% and 68.5% (LD), 61.7% and 30.9% (OTO), and 64.1% and 39.9%, respectively (YTO group; p < 0.0001 between the LD and the two DD groups). There was no difference in outcome between patients in their 60's and their 70's. Factors associated with mortality included: age (HR-1.060), DM (HR-1.773), IHD (HR-1.510), and LD/DD (HR-2.865). (3).

Conclusions: Our 17-years of experience seems to justify the rational of an old-to-old allocation policy in the elderly population. Live-donor transplant should be encouraged whenever possible. Each individual decision of elderly candidates for transplant should be based on the patient's comorbidity and predicted life expectancy.

Keywords: dialysis; elderly; expanded criteria donor; kidney transplantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier patient survival of LD, DD-OTO, and DD-YTO. DD, deceased donor; LD, living donor; OTO, old-to-old; YTO, Young-to-Old.
Figure 2
Figure 2
Kaplan–Meier graft survival of LD, DD-OTO, and DD-YTO. DD, deceased donor; LD, living donor; OTO, old-to-old; YTO, Young-to-Old.
Figure 3
Figure 3
Kaplan–Meier death censored graft survival of LD, DD-OTO, and DD-YTO. DD, deceased donor; LD, Living donor; OTO, old-to-old; YTO, Young-to-Old.
Figure 4
Figure 4
Graft survival: comparison between groups 60–69 and ≥70 years old.
Figure 5
Figure 5
Patient survival: comparison between groups 60–69 and ≥70 years old.
Figure 6
Figure 6
Estimated graft survival censored in death with functioning graft: comparison between groups 60–69 and ≥70 years old.
See this image and copyright information in PMC

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