Differential Outcomes of Expanded-Criteria Donor Renal Allografts According to Recipient Age

作者：Mezrich Joshua D^*; Pirsch John D; Fernandez Luis A; Foley David P; Bellingham Janet M; Odorico Jon S; Leverson Glen E; Munoz del Rio Alejandro; Solinger Hans W; Kaufman Dixon B; D'Alessandro Anthony M

来源：Clinical Journal of the American Society of Nephrology, 2012, 7(7): 1163-1171.

DOI：10.2215/CJN.00150112

Background and objectives Expanded-criteria donor (ECD) kidneys are used to expand the number of deceased-donor kidney transplants, often for elderly recipients. This study sought to determine whether older recipients had significantly worse outcomes from receiving ECD kidneys and whether outcomes of ECD versus standard-criteria donor (SCD) kidneys differed in younger recipients.
Design, setting, participants, & measurements This is a single-center, retrospective review of all primary deceased-donor kidney transplantations performed between 2000 and 2005. Group 1 consisted of patients >= 60 years of age (n=189) who received an ECD (n=96) or an SCD (n=93) kidney. Group 2 consisted of patients 40-59 years of age (n=370) who received an ECD (n=105) or an SCD (n=265) kidney.
Results Older recipients (group 1) who received ECD kidneys demonstrated significantly shortened 5-year actuarial patient and graft survival rates compared with older recipients of SCD allografts. Group 1 ECD recipients also had significantly worse outcomes than younger (group 2) ECD recipients. in multivariate analysis, ECD kidneys remained an independent predictor of poorer outcome in group 1.
Conclusions Morbidity and mortality were increased in elderly recipients of ECD kidneys. These findings may have implications in kidney allocation policy developments that encourage placement of ECD kidneys for older recipients. Clin J Am Soc Nephrol 7: 1163-1171, 2012. doi: 10.2215/CJN.00150112

• 出版日期2012-7