An old virtue to improve senior programs

Over the past decades, there have been significant demographic changes in patients awaiting deceased donor kidney transplants, with the largest increases in the ≥65 year-age group. Because most allograft failures in older recipients are the result of death with a functioning graft, the transplant community has adopted the position that older donor kidneys, with reduced half-lives, often can provide suitable, lifelong function for an elderly recipient. Since 1999, the Eurotransplant Senior Program (ESP) allocates kidneys from donors ≥65 years, without prospective matching for HLA antigens, to local transplant candidates ≥65 years. The rationale behind this policy was to expedite the change of the elderly to receive a transplant and to reduce cold ischemia time to prevent ischemic injury and hereby delayed graft function and the increased risk of rejection. Two issues have been identified with the use of old donor kidneys. First, there is an increased incidence of acute interstitial rejection, compared with kidneys from younger donors and secondly, once a rejection episode occurs, the ability to mount a tissue repair process seems impaired. Especially in the elderly, avoiding acute rejection must be balanced against the greater risk of excessive immunosuppression, putting these recipients at higher risk of infection and malignancy. Combined matching for age as well as HLA-DR antigens may further improve the results of Senior Programs.     

Expanding the donor pool to increase renal transplantation.

INTRODUCTION: The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome. METHODS: Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profiles. A re-addressing of the non-heart-beating donor pool was undertaken and an allocation scheme in which organs from donors aged >65 are allocated to recipients aged >65 [the Eurotransplant Senior Programme (ESP)] was introduced. RESULTS: Especially in The Netherlands, an enormous increase in the number of non-heart-beating donor kidneys has been observed, however with a pace-keeping reduction in heart-beating donors. The organization-wide implementation of the ESP has been successful. The 3 year graft survival rates for these age-matched transplants were as good as the human leukocyte antigen (HLA)-matched transplants (64 vs 67%) (P = 0.4). CONCLUSION: Within the framework of sound research, the utmost flexibility and creativity is needed to keep or even increase the number of renal transplants when faced with a quantitatively stagnating but qualitatively deteriorating donor pool. Both the non-heart-beating donor protocol and the ESP have proven to be quite successful in achieving this goal without compromising the outcome for the individual end-stage renal disease patient.     

10 Jahre „Eurotransplant Senior Program“

On 1 January 1999 Eurotransplant started the “Eurotransplant Senior Program” (ESP), the first program worldwide for age-matched kidney allocation and transplantation of expanded criteria donors (ECD). By now more than 4.300 kidneys from donors aged ≥65 were transplanted into recipients ≥65, with local or regional allocation according only to blood group compatibility and waiting time. Compared to ongoing dialysis, renal transplantation in the ESP offers longer patient survival and improved quality of life. The article evaluates the results of the ESP and of other studies dealing with renal transplantation of old donor kidneys into aged recipients. Specific aspects like the unexpectedly high acute rejection rate and ways to assess the residual renal function of aged donor kidneys are covered as well as the specific post-transplant risks of aged recipients.     

The influence of donor age on initial and long-term renal allograft outcome

Abstract To investigate the impact of donor age on the immediate and long-term graft outcome, 808 primary cadaveric renal allograft recipients, transplanted between January 1983 and December 1992, were divided into six groups according to donor age: 10–19 years ( n = 142), 20–29 years ( n = 214), 30–39 years ( n = 136), 40–49 years ( n = 146), 50–59 years ( n = 142), 60–69 years ( n = 28). The six groups were comparable with regard to donor origin (local/ distant), serum creatinine, cold ischemia and reanastomosis time, recipient sex, degree of presensitiza-tion, number of pretransplant blood transfusions, number of HLA-B and B/DR mismatches. The incidence of delayed graft function was linearly correlated with increasing donor age, from 11.9% (donors 10–19 years) to 39.3% (donors 60–69 years) (P< 0.0001). Graft survival at 3 years was not influenced by donor age (from 89.3% for the youngest donors to 84.4% for donors 60–69 years). After the 3rd decade, the creatinine clearance linearly decreased with donor age (6.2ml/min, P<0.01). This progressive decline could not be attributed to the recipient age (-7 ml/decade for 485 recipients <50 years, and -6.1 ml/decade for 323 patients ≥ 50 years). Despite the decreased function in older kidneys, recipient renal function remained remarkably stable between 1 and 3 years after transplantation within each donor age group.     

Evaluation of the Eurotransplant Senior Program. The Results of the First Year

On 4 January 1999, the Eurotransplant Senior Program (ESP) was implemented within the Eurotransplant kidney allocation scheme. PATIENTS AND METHODS: Kidneys obtained from donors aged over 65 years of age (65+) were allocated to a selected group of nonimmunized 65+ patients undergoing their first transplant. All transplants were performed locally to minimize cold-ischemic time. All transplants performed with kidneys from elderly donors that were allocated via ESP (ESP group) were compared to transplants performed with similar kidneys allocated via the standard renal allocation system (control group). Initial kidney function and 1-year graft outcome were assessed. RESULTS: In 1999, 227 ESP and 102 control transplants were performed. The duration of cold-ischemic time was 12 and 19 h for the ESP and control groups, respectively. No rejection episodes occurred in 60% and 67% of the ESP patients and controls, respectively, while a direct kidney function was observed in 59% of ESP and 49% of control patients. The 1-year graft survival rates, censoring for graft losses due to deaths in patients with functioning grafts, were 86% and 79%, respectively. CONCLUSION: An old-for-old renal allocation algorithm can be successful provided that risk factors, such as cold-ischemic time, are reduced.     

Renal transplantation in the elderly: surgical complications and outcome with special emphasis on the Eurotransplant Senior Programme.

BACKGROUND: The purpose of this retrospective study was to evaluate the results of the Eurotransplant Senior Programme (ESP) within our centre compared to elderly recipients >or=60 years from the regular Eurotransplant Kidney Allocation System (ETKAS), specifically focusing on surgical aspects. METHODS: Data from 73 ESP patients (average donor/recipient age: 71.1/67.1) were compared with those from 51 patients (49.7/63.6) treated within the framework of the ETKAS program between the years 1999 and 2006. The mean follow-up was 39.5 months. RESULTS: Cold ischaemic time (ESP versus ETKAS: 10.3 versus 15.0 h), duration of renal replacement therapy (42.2 versus 76.8 months), donor glomerular filtration rate (81.7 versus 109.9 ml/min/1.73 m(2)) and HLA mismatches (4.1 versus 2.4) were significantly different between the two groups (all P < 0.001). Primary graft function was seen in 74% ESP versus 69% of ETKAS patients (P > 0.05). The rate of surgical complications in the ESP versus ETKAS group was 47% versus 28% (P = 0.031) and the revision rate, 33% versus 24% (P = 0.259). Three-year patient and censored graft survival was 84% versus 92% and 85% versus 88% in the ESP and ETKAS group, respectively (all P > 0.05). Ninety-five percent of all deceased patients died with a functioning graft. CONCLUSIONS: The donor and recipient pool has been markedly expanded through ESP with similar patient and graft survival compared to elderly recipients grafted according to ETKAS criteria. However, patients and their physicians should be aware of the high surgical complication rate in elderly recipients, particularly when receiving elderly donor kidneys. This might seriously influence postoperative patient management but ultimately does not compromise the transplant outcome.     

Influence of recipient and donor age in pediatric renal transplantation

Abstract. The influence of recipient and donor age on the outcome of first cadaver kidney transplants was analyzed in a series of 1325 pediatric recipients and in 4230 transplants from pediatric kidney donors. Graft survival improved significantly with increasing recipient age ( P < 0.0001) and donor age ( P < 0.0001). Combined analysis of recipient and donor age groups revealed an overriding effect of donor age on graft outcome. Kidneys from donors younger than 3 years old consistently yielded poor results regardless of recipient age. Kidneys from adult donors gave the best results even in young recipients 0–5 years of age. With adult donor kidneys in cyclosporin-treated patients, high 1-year graft survival rates of 86 9% (SE) in 15 0-to 5-year-old recipients, 85 3% in 137 6-to 12-year-old recipients, and 83 1% in 6027 13-to 40-year-old recipients were observed.     

Nierenspende und Nierentransplantation im Alter

The likelihood of terminal renal insufficiency escalates with age, increasing the risk of dying as a patient requiring dialysis. In 1999, Eurotransplant initiated the Eurotransplant Senior Programm (ESP), in which the kidneys of old donors (>64 years) are allocated to recipients 64 years and older. Allocation does not take HLA-matching into account and is performed regionally only according to blood-group-compatibility to keep the storage time short. As a consequence of the short ischemic time, and thus reduced non-immunological damage to the anyways susceptible old kidney, graft-function and graft-survival in the ESP are very good. The results of the initial 5 years of this program show that it successfully utilizes more kidneys from old donors and that more old recipients are being transplanted, with a satisfactory graft-function. Increased donor- and/or recipient age require a thorough evaluation to exclude malignant and other diseases. Furthermore, short term controls on the waiting list and following kidney transplantation are prerequisites for successful transplantation in the aged recipient. If this is guaranteed, kidney transplantation in the old recipient-even with old donor organs-is a good alternative to the morbidity of a prolonged dialysis. Nevertheless, the role of HLA-matching should be reconsidered to reduce rejections.     

The advantage of allocating kidneys from old cadaveric donors to old recipients: a single-center experience

BACKGROUND: In January 1999 a new kidney allocation program was launched by the Eurotransplant Foundation, the 'Eurotransplant Senior Program' (ESP). Cadaveric donors above the age of 65 yr are allocated to kidney transplant recipients of the same age group. METHODS: Using a single-center database, 91 patients who underwent first renal transplantation at the age of 65 yr and older in the years 1999-2002 were identified. Fifty-six patients were transplanted through ESP allocation (study group) and 35 patients (control group) via normal Eurotransplant Kidney Allocation System (ETKAS) procedure. RESULTS: Age, sex and comorbid conditions did not differ by group. The rate of acute rejection episodes, primary non-function, delayed graft function, perioperative mortality did not differ by group. Serum creatinine was significantly lower in the ETKAS group (1.3 vs. 1.9 mg/dL; p=0.015) from six months after the transplantation on. Overall graft survival at six yr was 56% in the ETKAS group and 52% in the ESP group. With 73% in the ETKAS group and 71% in the ESP group, cumulative patient survival according to the Kaplan-Meier estimation was not statistically different at five yr. CONCLUSIONS: We did not find a relevant difference in the outcome between young and old kidney transplants in old recipients after this long observation period.     

Long-term patient and graft survival in the eurotransplant senior program: a single-center experience

BACKGROUND: The Eurotransplant Senior Program (ESP) was launched in 1999, targeted to increase the supply of donor kidneys to the elderly. This program requires local allocation of kidneys from cadaveric donors >65 years to recipients >65 years. METHODS: Of all patients >65 years who received a kidney transplant in 1999-2002 at our center, 59 patients were transplanted through the ESP protocol (ESP group), and 44 patients received a transplant from a younger donor (EuroTransplant Kidney Allocation System, ETKAS group). Recipients were followed for up to 5.3 years using the Austrian Dialysis and Transplant Registry. Outcomes studied included all-cause mortality and allograft loss. RESULTS: Age, sex, and comorbid conditions did not differ by group. Donor age was higher (69 vs. 36 years; P < 0.001) and cold ischemia time shorter in the ESP group (10 vs. 15 hr; P < 0.001). Number of HLA mismatches was greater in the ESP group (3.8 vs. 3.0; P = 0.003). ESP patients were more likely to receive induction therapy and less likely to receive cyclosporine A. Primary nonfunction, delayed graft function, operative mortality, rate of acute rejection episodes, and length of stay did not differ by group. Although serum creatinine at discharge was higher in ESP patients (1.7 vs. 1.4 mg/dL; P < 0.001), 4-year mortality (hazard ratio [HR] = 0.68; 95% CI: 0.31-1.49) and graft loss (HR = 0.61; 95% CI: 0.29-1.28) tended to be less. CONCLUSIONS: Long-term patient and graft survival were comparable between elderly patients who received their organ via the ESP and the regular ETKAS algorithm.     

Selective Use of Older Adults in Right Lobe Living Donor Liver Transplantation

Many centers are reluctant to use older donors (>44 years) for adult right-lobe living donor liver transplantation (RLDLT) due to concerns about possible increased morbidity in donors and poorer outcomes in recipients. Since 2000, 130 adult RLDLTs have been performed at our institution. Recipients were divided into those who received a right lobe graft from a donor ≤age 44 (n = 89, 68%; median age 30) and those who received a liver graft from a donor age >44 (n = 41, 32%; mean age 52). The two donor and recipient populations had similar demographic and operative profiles. With a median follow-up of 29 months, the severity and number of complications in older donors were similar to those in younger donors. No living donor died. Older donor allografts had initial allograft dysfunction compared to younger donors. Complication rates were similar among recipients in both groups but there was a higher bile duct stricture rate with older donor grafts (27% vs. 12%; p = 0.04). One-year recipient graft survival was 86% for older donors and 85% for younger donors (p = 0.95). Early experience with the use of selected older adults (>44 years) for RLDLT is encouraging, but may be associated with a higher rate of biliary complications in the recipient.     

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

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.     

Implication of advanced donor age on the outcome of liver transplantation

Historically, age has been considered to be a relative contraindication for organ donors. The use of elderly donors for liver transplantation remains controversial due to the fear of inferior outcome. According to United Network for Organ Sharing (UNOS) data, the proportion of older donors has been increasing annually. This study describes the short‐ and long‐term outcomes for transplantation of elderly donor livers. Three hundred and seventy‐four primary liver transplantations, which had been performed at the University of Virginia Health System from 7 February 1988 to 31 December 1998, were included. Graft survival, incidence of primary non‐function, and hepatic artery thrombosis (HAT) after transplantation according to the different age groups of liver donors were analyzed. Cases were analyzed by donor age (group I, n=106: aged <20 yr; group II, n=217: aged between 20 and 49 yr; group III, n=51: aged ≥50 yr), and by donor age in comparison with recipient age (group IV, n=65: recipients transplanted with organs from donors within 5 yr of their age; group V, n=266: recipients from donors> 5 yr younger than their age; group VI, n=43: recipients from donors> 5 yr older than their age). Group III or VI (group of advanced donor age) and group II or V (control group) were compared by age, gender, race, body weight, height, pre‐transplantation cytomegalovirus (CMV) status of the recipients donors, cause of brain death of donors, total or warm ischemic time, ABO matching, and degree of human leucocyte antigen (HLA) mismatching. No significant difference in 5 yr graft survival was found between the groups by donor age (p=0.604) and by donor age compared with recipient age (p=0.567). Moreover, no significant differences in the incidence of primary non‐function and HAT after transplantation were found between the groups by donor age and by donor age compared with recipient age. Older donors were more likely to be women and to have antibodies to CMV, as well as to have died by cerebrovascular causes. Race, body weight, height of both recipients and donors, total or warm ischemic time of grafts, ABO matching, and degree of HLA mismatching were not significantly different between the groups. We conclude from this study that advanced donor age is not a contraindication to liver transplantation if careful assessment of donors is made on a case‐by‐case basis. There is a need to maintain an open mind with regard to the use of livers from older donors due to the current situation of serious organ shortages.     

Recipient Outcomes for Expanded Criteria Living Kidney Donors: The Disconnect Between Current Evidence and Practice

Older individuals or those with medical complexities are undergoing living donor nephrectomy more than ever before. Transplant outcomes for recipients of kidneys from these living expanded criteria donors are largely uncertain. We systematically reviewed studies from 1980 to June 2008 that described transplant outcomes for recipients of kidneys from expanded criteria living donors. Results were organized by the following criteria: older age, obesity, hypertension, reduced glomerular filtration rate (GFR), proteinuria and hematuria. Pairs of reviewers independently evaluated each citation and abstracted data on study and donor characteristics, recipient survival, graft survival, serum creatinine and GFR. Transplant outcomes for recipients of kidneys from older donors (≥60 years) were described in 31 studies. Recipients of kidneys from older donors had poorer 5-year patient and graft survival than recipients of kidneys from younger donors [meta-analysis of 12 studies, 72% vs. 80%, unadjusted relative risk (RR) of survival 0.89, 95% confidence interval (CI) 0.83–0.95]. In meta-regression, this association diminished over time (1980s RR 0.79, 95% CI 0.65–0.96 vs. 1990s RR 0.91, 95% CI 0.85–0.99). Few transplant outcomes were described for other expanded criteria. This disconnect between donor selection and a lack of knowledge of recipient outcomes should give transplant decision-makers pause and sets an agenda for future research.     

"Old-for-old" cadaveric renal transplantation: surgical findings, perioperative complications and outcome

OBJECTIVE: To evaluate the surgical findings and outcome of locally allocated, blood-group-compatible but HLA-unmatched cadaveric kidneys in first renal transplantation of donor/recipient pairs aged 65 years and above (Eurotransplant Senior Program=ESP). METHODS: 26 patients of the study group (donor age 70.4 +/- 3.6/recipient age 67.7 +/- 2.8) were compared to 30 controls aged 60 and above (mean recipient age 62.6 +/- 2.3/mean donor age 43.8 +/- 15.3). For controls kidney allocation included HLA matching. RESULTS: Cold ischemic time (ESP vs. controls 501 vs. 883 min; p<0.05) and mean number of HLA mismatches (4.2 +/- 1.36 vs. 1.6 +/- 1.62; p<0.05) differed significantly. Delayed graft function was lower in the study group (12% vs. 43%; p<0.05), rejection episodes in the ESP group were numerous but did not differ significantly from the controls (46% vs. 30%; p=0.21). More intraoperative complications and a higher incidence of donor organ arteriosclerosis (p<0.05) were seen in the ESP group. Three-year graft survival uncensored and censored for death with functioning graft did not differ, even though mean creatinine and creatinine clearance differed significantly beginning at month three. Three-year patient survival (55% vs. 81%) differed in favour of the control group, even though the difference was not significant due to small number of patients. CONCLUSION: "Old-for-old" kidney transplantation with local allocation yields graft survival rates comparable to HLA-matched young grafts and is a good approach to extend the donor and recipient pool. Careful patient selection is advised.     

The impact of donor and recipient age on the outcome of kidney transplantation

BACKGROUND: As survival has improved in the general population over the last few decades, the age of patients participating in renal transplantation has also increased. This study sought to investigate the impact of donor and recipient age as predictors of long-term graft survival in renal transplantation. MATERIALS AND METHODS: We analyzed transplantation outcomes in 598 patients who received renal transplants from 1979 to 2002. Patients were divided into 4 groups according to their age at renal transplantation. Group A (donor age <50 years, recipient age >50 years, n = 19/3.2%); group B (donor age >50 years, recipient age <50 years, n = 153/25.5%); group C (donor age <50 years, recipient age >50 years, n = 69/11.6%), and group D (donor age <50 years, recipient age <50 years, n = 357/59.8%). Univariate analysis to assess the effect of donor and recipient age as predictor factors of graft outcome was complimented by Kaplan-Meier and log-rank methods to assess graft survival with P < 1.05 considered significant. RESULTS: In the elderly donor group, graft survival was 92.8% at 1 year and 85.6% at 3 years; in the younger donor group, they were 93.4% and 90.2%, respectively, a difference that was statistically significant (P = .02). Univariate analysis of age factors showed a significant reduction in graft survival among recipients who received kidneys transplants from donors older than 50 years, although recipient age >50 years was not found to be an independent risk factor. The incidence of acute rejection was 24.6% in the elderly donor group and 23.5% in the younger donor group (P = not significant). Among the 4 groups, the best result was group D with 1-year and 3-year graft survival rates of 93.3% and 90.5%, respectively, but this result was not statistically significant. CONCLUSIONS: These results may help the design for transplantation strategies for kidneys procured from elderly donors and for allocation to elderly recipients.     

Influence of recipient and donor age in pediatric renal transplantation

The influnece of recipient and donor age on the outcome of first cadaver kidney transplants was analyzed in a series of 1325 pediatric recipients and in 4230 transplants from pediatric kidney donors. Graft survival improved significantly with increasing recipient age (P<0.0001) and donor age (P<0.0001). Combined analysis of recipient and donor age groups revealed an overriding effect of donor age on graft outcome. Kidneys from donors younger than 3 years old consistently yielded poor results regardless of recipient age. Kidneys from adult donors gave the best results even in young recipients 0–5 years of age. With adult donor kidneys in cyclosporin-treated patients, high 1-year graft survival rates of 86±9% (SE) in 15 0-to 5-year-old recipients, 85±3% in 137 6-to 12-year-old recipients, and 83±1% in 6027 13-to 40-year-old recipients were observed.     

Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

Allocation of kidneys from donors older than 64 years to recipients older than 64 years was started in 1999 to improve use of older donor kidneys. Kidneys are allocated locally without HLA-matching to keep cold ischemia short. We compared survival and rejection rates in elderly patients allocated in the old-for-old program (ESP) to patients aged 60 years and older based on HLA-matching, expected ischemia and waiting time (ETKAS). The 69 ESP patients were older (67.9 +/- 2.5 vs. 63.9 +/- 2.9 years), had older donors (71.2 +/- 3.9 vs. 44.6 +/- 14.5 years) and more HLA-mismatches (4.2 +/- 1.2 vs. 1.6 +/- 1.7) than the 71 ETKAS patients, while ischemia was shorter (7.8 +/- 3.4 vs. 14.2 +/- 5.5 h). ESP and ETKAS had similar graft (1-year: 83.6% vs. 86.9%) and patient survival (85.2% vs. 89.5%). With the introduction of ESP, use of older recipients and donors rose from less than 2% to 16% and 11%, respectively. Incidence of acute rejections was significantly higher in the ESP group (1 year: 43.2% vs. 27.4%) and significantly correlated with the degree of HLA-matching. Introduction of old-for-old allocation allows successful expansion of the donor and recipient pool without affecting patient and graft survival. HLA-matching should not be ignored, as the risk of acute rejection in elderly patients is substantial.     

Age-matching in renal transplantation.

BACKGROUND: So far, the combined influence of donor age and recipient age on renal allograft survival has not been investigated sufficiently. In this retrospective single-centre study we analysed whether the influence of donor age and recipient age on renal allograft survival are dependent on each other. METHODS: Data from 1269 cadaveric renal allograft transplantations were evaluated. Paediatric donors (<15 years) and paediatric recipients (<15 years) were excluded. Donors and recipients were divided by age: young donors (yd, 55 years, n=176), young recipients (yr, 55 years, n=211). Functional and actual long-term graft survival (8 years) within the four resulting groups was determined: yd/yr (n=926), yd/or (n=167), od/yr (n=132), and od/or (n=44). RESULTS: Univariate analysis showed that long-term graft survival of both, kidneys from young donors (functional, 66.1 vs 52.2%, P=0.004; actual, 53.3 vs 46.2%, P=0.065) and kidneys from old donors (functional, 68.7 vs 22.5%, P=0.07; actual, 57.1 vs 20.8%, P=0.15) was better in old recipients as compared to young recipients. Multivariate regression analysis revealed that actual graft survival of kidneys from old donors was significantly reduced in young recipients (od/yr) as compared to all other groups (P=0.001; RR, 1. 97; 95% CI, 1.32-2.94). In this group of patients, graft loss was mainly due to acute (33.7%) and chronic (24.0%) rejection. CONCLUSION: Transplantation of kidneys from 'old' donors into 'young' recipients should be avoided, and these kidneys should be given to age-matched recipients.     

Survival of cadaveric renal transplant grafts from young donors and in young recipients

Evidence from multicenter registries has suggested that cadaveric renal graft survival is poorer when either the recipient or the donor is very young. We therefore analyzed our results from a single pediatric center. There was a significant correlation between greater recipient age and improved cadaveric graft (P=0.002) and patient (P=0.0009) survival. The age of the donor also appeared important, particularly in very young children, but became less so as donor age rose. Forty-four percent of recipients under 3 years old who received cadaveric kidneys from donors less than 4 years old lost their grafts as a result of renal thrombosis, ischemia, or technical problems, compared with only 3% of recipients over 9 years of age, whose grafts came from donors who were also over 9 years. The 1-year first cadaveric graft survival rates for these two age groups were 33% and 82% respectively. Our experience confirms the poor findings reported in very young recipients and with very young donors.