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Observational Study
. 2024 Aug 23:37:13452.
doi: 10.3389/ti.2024.13452. eCollection 2024.

Benefits of Living Over Deceased Donor Kidney Transplantation in Elderly Recipients. A Propensity Score Matched Analysis of a Large European Registry Cohort

Néstor Toapanta  1 , Jordi Comas  2 , Ignacio Revuelta  3 , Anna Manonelles  4 , Carme Facundo  5 , María José Pérez-Saez  6 , Anna Vila  7 , Emma Arcos  2 , Jaume Tort  2 , Magali Giral  8 , Maarten Naesens  9 , Dirk Kuypers  9 , Anders Asberg  10   11 , Francesc Moreso #  1 , Oriol Bestard #  1 ; EKITE consortium
Affiliations
Observational Study

Benefits of Living Over Deceased Donor Kidney Transplantation in Elderly Recipients. A Propensity Score Matched Analysis of a Large European Registry Cohort

Néstor Toapanta et al. Transpl Int. .

Abstract

Although kidney transplantation from living donors (LD) offers better long-term results than from deceased donors (DD), elderly recipients are less likely to receive LD transplants than younger ones. We analyzed renal transplant outcomes from LD versus DD in elderly recipients with a propensity-matched score. This retrospective, observational study included the first single kidney transplants in recipients aged ≥65 years from two European registry cohorts (2013-2020, n = 4,257). Recipients of LD (n = 408), brain death donors (BDD, n = 3,072), and controlled cardiocirculatory death donors (cDCD, n = 777) were matched for donor and recipient age, sex, dialysis time and recipient diabetes. Major graft and patient outcomes were investigated. Unmatched analyses showed that LD recipients were more likely to be transplanted preemptively and had shorter dialysis times than any DD type. The propensity score matched Cox's regression analysis between LD and BDD (387-pairs) and LD and cDCD (259-pairs) revealing a higher hazard ratio for graft failure with BDD (2.19 [95% CI: 1.16-4.15], p = 0.016) and cDCD (3.38 [95% CI: 1.79-6.39], p < 0.001). One-year eGFR was higher in LD transplants than in BDD and cDCD recipients. In elderly recipients, LD transplantation offers superior graft survival and renal function compared to BDD or cDCD. This strategy should be further promoted to improve transplant outcomes.

Keywords: deceased donor; elderly renal transplant; living donor; propensity score analysis; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow-chart of the included population.
FIGURE 2
FIGURE 2
Distribution of time on dialysis across the different donor sources. LD, living donor; DBD, donors after brain death; cDCD, donor after controlled circulatory death.
FIGURE 3
FIGURE 3
Graft survival including graft failure and patient death with functioning graft (A), death-censored graft survival (B) and patient survival censoring after graft loss (C) in kidney transplants performed during 2013–2021 in the European cohort. Log-rank p-value for all comparisons is displayed. LD, living donors; BDD, donors after brain death; cDCD, donor after controlled circulatory death.
FIGURE 4
FIGURE 4
Graft survival including patient death (A, B), death-censored graft survival (C, D) and patient survival (E, F) in kidney transplants performed during 2013–2021 in the European cohort matched by the propensity score. Log-rank p-value for all comparisons is displayed. LD, living donors; BDD, donors after brain death; cDCD, donors after controlled circulatory death.
FIGURE 5
FIGURE 5
Evolution of renal function (eGFR according to the CKD-EPI formula) up to 3 years in the matched cohorts. LD, living donor; BDD, donors after brain death; cDCD, donor after controlled circulatory death; eGFR, estimated Glomerular Filtration Rate by the CKD-EPI formula.
FIGURE 6
FIGURE 6
Evolution of renal function in kidney donors after nephrectomy (eGFR according to the CKD-EPI formula).
See this image and copyright information in PMC

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