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Clinical Epidemiology
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Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors

Hessel Peters-Sengers, Stefan P. Berger, Martin B.A. Heemskerk, Doaa al Arashi, Jaap J. Homan van der Heide, Aline C. Hemke, Ineke J.M. ten Berge, Mirza M. Idu, Michiel G.H. Betjes, Arjan D. van Zuilen, Luuk B. Hilbrands, Aiko P.J. de Vries, Azam S. Nurmohamed, Maarten H. Christiaans, L.W. Ernest van Heurn, Johan W. de Fijter and Frederike J. Bemelman
JASN February 2017, 28 (2) 621-631; DOI: https://doi.org/10.1681/ASN.2015080879
Hessel Peters-Sengers
*Departments of Nephrology and
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Stefan P. Berger
†Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands;
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Martin B.A. Heemskerk
‡Netherlands Organ Transplant Registry, Dutch Transplant Foundation, Leiden, The Netherlands;
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Doaa al Arashi
*Departments of Nephrology and
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Jaap J. Homan van der Heide
*Departments of Nephrology and
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Aline C. Hemke
‡Netherlands Organ Transplant Registry, Dutch Transplant Foundation, Leiden, The Netherlands;
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Ineke J.M. ten Berge
*Departments of Nephrology and
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Mirza M. Idu
§Surgery, Academic Medical Center, Amsterdam, The Netherlands;
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Michiel G.H. Betjes
‖Department of Nephrology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands;
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Arjan D. van Zuilen
¶Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands;
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Luuk B. Hilbrands
**Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands;
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Aiko P.J. de Vries
††Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands;
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Azam S. Nurmohamed
‡‡Department of Nephrology, Vrije University Medical Center, Amsterdam, The Netherlands; and
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Maarten H. Christiaans
§§Departments of Nephrology and
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L.W. Ernest van Heurn
‖‖Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Johan W. de Fijter
††Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands;
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Frederike J. Bemelman
*Departments of Nephrology and
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Abstract

An increasing number of elderly patients (≥65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (≥18 years) who received a first DBD or DCD kidney during 2002–2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type. In multiple logistic regression analysis, elderly recipients of elderly DCD kidneys experienced more delayed graft function and acute rejection than did elderly recipients of young DBD kidneys (odds ratios 10.43 [95% confidence interval (95% CI), 5.75 to 18.91] and 2.78 [95% CI, 1.35 to 5.73], respectively). In Cox regression analysis, elderly recipients of elderly DCD kidneys had a 5-year mortality risk higher than that of elderly recipients of young DBD kidneys (hazard ratio, 1.86; 95% CI, 1.15 to 3.02). Elderly recipients of elderly kidneys had a 5-year mortality rate comparable to that of waitlisted elderly patients remaining on dialysis. Among elderly recipients, 63.8% of those who received elderly DCD kidneys, 45.5% of those who received elderly DBD kidneys, and approximately 26% of those who received young DBD or DCD kidneys had an eGFR<30 ml/min per 1.73 m2 (including primary nonfunction) after 1 year. In conclusion, improving donor selection and preservation is warranted if the allocation of elderly DCD grafts to elderly recipients is to be expanded.

  • kidney transplantation
  • Donation after circulatory death
  • Donation after brain death
  • Elderly donors
  • Elderly recipients
  • Eurotransplant Senior Program
  • Copyright © 2017 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 28 (2)
Journal of the American Society of Nephrology
Vol. 28, Issue 2
February 2017
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Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors
Hessel Peters-Sengers, Stefan P. Berger, Martin B.A. Heemskerk, Doaa al Arashi, Jaap J. Homan van der Heide, Aline C. Hemke, Ineke J.M. ten Berge, Mirza M. Idu, Michiel G.H. Betjes, Arjan D. van Zuilen, Luuk B. Hilbrands, Aiko P.J. de Vries, Azam S. Nurmohamed, Maarten H. Christiaans, L.W. Ernest van Heurn, Johan W. de Fijter, Frederike J. Bemelman
JASN Feb 2017, 28 (2) 621-631; DOI: 10.1681/ASN.2015080879

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Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors
Hessel Peters-Sengers, Stefan P. Berger, Martin B.A. Heemskerk, Doaa al Arashi, Jaap J. Homan van der Heide, Aline C. Hemke, Ineke J.M. ten Berge, Mirza M. Idu, Michiel G.H. Betjes, Arjan D. van Zuilen, Luuk B. Hilbrands, Aiko P.J. de Vries, Azam S. Nurmohamed, Maarten H. Christiaans, L.W. Ernest van Heurn, Johan W. de Fijter, Frederike J. Bemelman
JASN Feb 2017, 28 (2) 621-631; DOI: 10.1681/ASN.2015080879
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Keywords

  • kidney transplantation
  • Donation after circulatory death
  • Donation after brain death
  • Elderly donors
  • Elderly recipients
  • Eurotransplant Senior Program

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