Prospective Age-Matching in Elderly Kidney Transplant Recipients—A 5-Year Analysis of the Eurotransplant Senior Program |
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| Authors: | U. Frei J. Noeldeke V. Machold-Fabrizii H. Arbogast R. Margreiter L. Fricke A. Voiculescu V. Kliem H. Ebel U. Albert K. Lopau P. Schnuelle B. Nonnast-Daniel F. Pietruck R. Offermann G. Persijn C. Bernasconi |
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| Affiliation: | Department of Nephrology and Medical Intensive Care, Charité- Universitätsmedizin Berlin, CharitéCampus-Virchow-Klinikum, Berlin, Germany;Hoffmann La Roche AG, Switzerland;Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria;Division of Transplantation Surgery, Medical Center, University of Munich, Munich, Germany;Department of General and Transplant Surgery, Innsbruck, Austria;Department of Medicine I, Division of Nephrology, University of Luebeck School of Medicine, Luebeck, Germany;Department of Nephrology, Heinrich-Heine-University, Duesseldorf, Germany;Nephrologisches Zentrum Niedersachsen, Hann. Muenden, Germany;Clinic of Internal Medicine and Nephrology, Philipps-University, Marburg, Germany;Westpfalz- Klinikum Kaiserslautern Department of Nephrologie and Transplantation;, Department of Medicine, Division of Nephrology, University of Wuerzburg, Germany;Vth Medical Clinic (Nephrology, Endocrinology), University Hospital Mannheim, Medical Faculty of the University of Heidelberg, Mannheim, Germany;Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany;Department of Nephrology, School of Medicine, Universitiy Hospital Essen, Germany;Eurotransplant International Foundation, Leiden, The Netherlands;Limites Medical Research Ltd, Vacallo, Switzerland |
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| Abstract: | ![]()
Renal transplantation faces challenges: the organ shortage resulting in extended waiting times and an aging population resulting in death with a functioning graft. The Eurotransplant Senior Program (ESP) allocates kidneys within a narrow geographic area from donors aged ≥65 years to recipients ≥65 years regardless of HLA. This analysis investigates the impact of the ESP on waiting time, graft and patient survival. The ESP group (n = 1406, old to old) was compared to two groups allocated via the Eurotransplant Kidney Allocation System (ETKAS) with either similar donor age (old to any [O/A], donor age ≥65, n = 446) or recipient age (any to old, [A/O], recipient age 60–64, n = 1687). All patients were transplanted between 1999 and 2004. Since initiation of the ESP (1999), availability of elderly donors doubled and waiting time for ESP patients decreased. Local allocation led to shorter cold ischemia time (11.9 vs. >17.0 h, p < 0.001) and less delayed graft function (DGF, ESP 29.7% vs. O/A 36.2%, p = 0.047) but 5–10% higher rejection rates. Graft and patient survival were not negatively affected by the ESP allocation when compared to the standard allocation. The ESP age matching of elderly donors and recipients is an effective allocation system for organs from elderly donors. |
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| Keywords: | Age matching cold ischemia time deceased donor renal transplantation Eurotransplant Senior Program expanded criteria donor old-for-old allocation waiting list |
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