A Lifetime of Allograft Function with Kidneys from Older Donors |
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Authors: | Caren Rose Elke Schaeffner Ulrich Frei Jagbir Gill John S Gill |
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Institution: | *Division of Nephrology, University of British Columbia, Vancouver, Canada;;†Division of Nephrology, Charité University Medicine, Berlin, Germany;;‡Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; and;§Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts |
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Abstract: | Strategies to increase expanded criteria donor (ECD) transplantation are needed. We quantified the extent to which ECD kidneys provide recipients with a lifetime of allograft function by determining the difference between patient survival and death-censored allograft survival (graft survival). Initial analyses compared 5-year outcomes in the Eurotransplant Senior Program (European) and the United States Renal Data System. Among European recipients ≥65 years, patient survival exceeded graft survival, and ECD recipients returned to dialysis for an average of 5.2 months after transplant failure. Among United States recipients ≥60 years, graft survival exceeded patient survival. Although patient survival in elderly recipients in the United States was low (49% at 5 years), the average difference in patient survival at 10 years in elderly recipients in the United States with an ECD versus non-ECD transplant was only 7 months. The probability of patient survival with a functioning allograft at 5 years was higher with ECD transplantation within 1 year after activation to the waiting list than with delayed non-ECD transplantation ≥3 years after activation to the waiting list. Subsequent analyses demonstrated that ECD transplants do not provide a lifetime of allograft function in recipients <50 years in the United States. These findings should encourage ECD transplantation in patients ≥60 years, demonstrate that rapid ECD transplantation is superior to delayed non-ECD transplantation, and challenge the policy in the United States of allowing patients <50 years to receive an ECD transplant. |
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Keywords: | transplantation survival expanded criteria donors health policy cadaver organ transplantation |
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