Simultaneous heart-kidney transplantation results in respectable long-term outcome but a high rate of early kidney graft loss in high-risk recipients – a European single center analysis

Abstract Background In spite of renal graft shortage and increasing waiting times for transplant candidates, simultaneous heart and kidney transplantation (HKTx) is an increasingly performed procedure established for patients with combined end-stage cardiac and renal failure. Although data on renal graft outcome in this setting is limited, reports on reduced graft survival in comparison to solitary kidney transplantation (KTx) have led to an ongoing discussion of adequate organ utilization. Methods This retrospective study was conducted to evaluate prognostic factors and outcomes of 27 patients undergoing HKTx in comparison to a matched cohort of 27 patients undergoing solitary KTx between September 1987 and October 2019 in one of Europe’s largest transplant centers. Results Median follow-up was 100.33 (0.46–362.09) months. Despite lower five-year kidney graft survival (62.6% versus 92.1%; 111.73 versus 183.08 months; p = 0.189), graft function and patient survival (138.90 versus 192.71 months; p = 0.128) were not significantly inferior after HKTx in general. However, in case of prior cardiac surgery requiring sternotomy we observed significantly reduced early graft and patient survival (57.00 and 94.09 months, respectively) when compared to patients undergoing solitary KTx (183.08 and 192.71 months; p < 0.001, respectively) or HKTx without prior cardiac surgery (203.22 and 203.22 months; p = 0.016 and p = 0.019, respectively), most probably explained by the significantly increased rate of primary nonfunction (33.3%) and in-hospital mortality (25.0%). Conclusions Our data demonstrates the increased rate of early kidney graft loss and thus significantly inferior graft survival in high-risk patients undergoing HKTx. Thus, we advocate for a “kidney-after-heart” program in such patients to ensure responsible and reasonable utilization of scarce resources in times of ongoing organ shortage crisis.

Download Full-text

Impact of Early Pancreatic Graft Loss on Outcome after Simultaneous Pancreas–Kidney Transplantation (SPKT)—A Landmark Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10153237 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3237

Author(s):

Lukas Johannes Lehner ◽

Robert Öllinger ◽

Brigitta Globke ◽

Marcel G. Naik ◽

Klemens Budde ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Graft Loss ◽

Type I ◽

Kidney Graft ◽

Landmark Analysis ◽

Pancreas Kidney Transplantation ◽

Simultaneous Pancreas Kidney ◽

Simultaneous Pancreas Kidney Transplantation ◽

Pancreas Graft

(1) Background: Simultaneous pancreas–kidney transplantation (SPKT) is a standard therapeutic option for patients with diabetes mellitus type I and kidney failure. Early pancreas allograft failure is a complication potentially associated with worse outcomes. (2) Methods: We performed a landmark analysis to assess the impact of early pancreas graft loss within 3 months on mortality and kidney graft survival over 10 years. This retrospective single-center study included 114 adult patients who underwent an SPKT between 2005 and 2018. (3) Results: Pancreas graft survival rate was 85.1% at 3 months. The main causes of early pancreas graft loss were thrombosis (6.1%), necrosis (2.6%), and pancreatitis (2.6%). Early pancreas graft loss was not associated with reduced patient survival (p = 0.168) or major adverse cerebral or cardiovascular events over 10 years (p = 0.741) compared to patients with functioning pancreas, after 3 months. Moreover, kidney graft function (p = 0.494) and survival (p = 0.461) were not significantly influenced by early pancreas graft loss. (4) Conclusion: In this study, using the landmark analysis technique, early pancreas graft loss within 3 months did not significantly impact patient or kidney graft survival over 10 years.

Download Full-text

P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1706 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yeonsoon Jung ◽

Jisu Kim ◽

Haesu Jeon ◽

Ye Na Kim ◽

Ho Sik Shin ◽

...

Keyword(s):

African American ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Graft Survival ◽

Cox Regression ◽

Patient Survival ◽

Graft Loss ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Data Set

Abstract Background African American kidney transplant recipients experience disproportionately high rates of graft loss. The aim of this analysis was to use a UNOS data set that contains detailed baseline and longitudinal clinical data to establish and quantify the impact of the current overall graft loss definition on suppressing the true disparity magnitude in US AA kidney transplant outcomes. Methods Longitudinal cohort study of kidney transplant recipients using a data set created by United Network for Organ Sharing (UNOS), including 266,128 (African American 70,215, Non-African American 195,913) transplant patient between 1987 and December 2016. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). Results 195,913 non-African American (AA) (73.6%) were compared with 70,215 AA (26.4%) recipients. 10-year-graft survival of AA in all era is lower than that of non-AA (31% in deceased kidney transplants (DKT) AA recipient and 42% in living kidney transplantation (LKT) non-AA recipient). 10-year-patient survival of AA with functioning graft in all era is similar that of non-AA. Multivariate Cox regression of factors associated with patient survival with functioning graft are acute rejection within 6 months, DM, hypertension and etc. Pre-transplant recipient BMI in AA show the trend as a protective factor in patient survival with functioning graft although not significantly in statistics Conclusions African American kidney transplant recipients experience a substantial disparity in graft loss, but not patient death with functioning graft.

Download Full-text

A functional TGFB1 polymorphism in the donor associates with long-term graft survival after kidney transplantation.

10.1101/2021.07.05.21260045 ◽

2021 ◽

Author(s):

Felix Poppelaars ◽

Mariana Gaya da Costa ◽

Bernardo Faria ◽

Siawosh K. Eskandari ◽

Jeffrey Damman ◽

...

Keyword(s):

Kidney Transplantation ◽

Kidney Transplant ◽

Graft Survival ◽

Graft Loss ◽

Kidney Graft ◽

Genotype Group ◽

Transplant Survival ◽

Increased Risk ◽

The Impact

Introduction Improvement of long-term outcomes in kidney transplantation remains one of the most pressing challenges, yet drug development is stagnating. Human genetics offers an opportunity for much-needed target validation in transplantation. Conflicting data exists about the effect of transforming growth factor beta 1 (TGF-beta1) on kidney transplant survival, since TGF-beta1 has profibrotic and protective effects. We therefore the impact of a recently discovered functional TGBF1 polymorphism on long term kidney graft survival. Methods We performed an observational cohort study analyzing recipient and donor DNA in 1,271-kidney transplant pairs from the University Medical Center Groningen in The Netherlands and associated a low-producing TGBF1 polymorphism (rs1800472 C>T) with 5, 10, and 15-year death-censored kidney graft survival. Results Donor genotype frequencies of s1800472 in TGBF1 differed significantly between patients with and without graft loss (P=0.042). Additionally, the low-producing TGBF1 polymorphism in the donor was associated with an increased risk of graft loss following kidney transplantation (HR 2.13 for the T allele; 95%-CI 1.16-3.90; P=0.015). The incidence of graft loss within 15 years of follow-up was 16.4% in the CC-genotype group and 28.9% in the CT-genotype group. After adjustment for transplant-related covariates, the association between the TGBF1 polymorphism in the donor and graft loss remained significant. In contrast, there was no association between the TGBF1 polymorphism in the recipient and graft loss. Conclusion Kidney allografts possessing a low-producing TGBF1 polymorphism have a higher risk of late graft loss. Our study adds to a growing body of evidence that TGFbeta1 is beneficial, rather than harmful, for kidney transplant survival.

Download Full-text

MO963GRAFT- AND PATIENT-SURVIVAL AFTER FIRST KIDNEY TRANSPLANT BIOPSY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0042 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Salmir Nasic ◽

Johan Mölne ◽

Bernd Stegmayr ◽

Marie Felldin ◽

Björn Peters

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Patient Survival ◽

Graft Loss ◽

Glomerular Diseases ◽

Hematological Diseases ◽

Antibody Mediated Rejection ◽

Transplant Kidney ◽

Grade Ii ◽

Transplant Biopsy

Abstract Background and Aims Kidney transplantation is frequently used as a treatment in uremic patients. However, long term function is not easily predicted. The aim of this study was to investigate to what extent histological diagnosis in the first registered transplant kidney biopsy is related to clinical outcome. Method Included were data of 1463 patients (36.6 % women, 63.4 % men) that were merged from a kidney transplantation register and a biopsy register. These patients obtained their first registered transplant biopsy during the period January 1, 2007 until July 30, 2017. Fisher’s exact test and χ-2 analyses were used for cross-tabulation of data. Graft- and patient-survival analysis was performed by Kaplan-Meier analysis with log-rank tests comparing different groups and in next step age and gender adjusted analysis were performed by multivariate Cox-regression-analysis. Data are presented as Hazard Ratio (HR) and 95% Confidence Intervals (CI). A two-sided p-value of <0.05 was considered as statistically significant. Results The graft-survival was shorter for patients with biopsy-proven glomerular diseases (HR 8.1, CI 3.1-20.7) and rejections (HR 4.3, CI 1.7 -10.5) compared to normal biopsy findings. Further, there was a shorter graft-survival for those with chronic damages (HR 3.2, CI 1.3-8.0), acute tubular injuries (HR 3.0, CI 1.2-7.8), and borderline changes (HR 2.9, CI 1.1-7.6). The patient-survival was reduced for patients with biopsy-proven hematological diseases (HR 9.6, CI 2.1-44.0). Sub analysis of all types of rejections showed shorter graft-survival for chronic T-cell-mediated rejection (TCMR) (HR 4.8, CI 2.1-11.7), active antibody-mediated rejection (ABMR) (HR 4.4, CI 2.1-9.3), chronic ABMR (HR 3.8, CI 2.2-6.7), combined chronic ABMR and TCMR (HR 4.0, CI 2.4-6.9) and other rejections (HR 3.3, CI 1.1-9.6) compared to acute TCMR. Patients with TCMR Banff grade II rejection had a better graft-survival (HR 0.35, CI 0.20-0.63) compared to other rejections as well as patients with TCMR Banff grade I (HR 0.52, CI 0.29-0.93). 265 patients had graft-loss and 42 of those patients died afterwards (15.8%). Of the 42 who died after graft-loss 9 patients died within 30 days after transplant failure (21.4%). Conclusion A shorter graft-survival was found in kidneys with glomerular diseases, rejections, acute tubular injuries, borderline changes and chronic damages. A shorter patient-survival was noted for patients with transplant kidney biopsies with hematological diseases. Patients with Banff grade II rejection had a better graft-survival compared to all other diagnosis and other rejections. Further, awareness should be given to patients the first month after graft-loss.

Download Full-text

Dispelling the myth of Asian homogeneity: Improved outcomes of Chinese Americans after kidney transplantation

Translation: The University of Toledo Journal of Medical Sciences ◽

10.46570/utjms.vol3-2016-201 ◽

2018 ◽

Vol 3 ◽

pp. 5-9

Author(s):

Farah Karipineni ◽

Afshin Parsikia ◽

PoNan Chang ◽

John Pang ◽

Stalin Campos ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Patient Survival ◽

Graft Loss ◽

Graft Function ◽

Chinese Americans ◽

The United States ◽

Chinese Patients ◽

One Year ◽

Patient And Graft Survival

Objectives: Asians represent the fastest growing ethnic group in the United States. Despite significant diversity within the group, many transplant studies treat Asians as a homogeneous entity. We compared patient and graft survival among major Asian eth- nicities to determine whether any subgroup has superior out- comes. Methods: We conducted a retrospective analysis of kidney trans- plants on Asian and White patients between 2001 and 2012. Co- variates included gender, age, comorbidities, and donor category. Primary outcomes included one-year patient and graft survival. Secondary outcomes included delayed graft function (DGF) and rejection as cause of graft loss and death. Results: Ninety-one Asian patients were identified. Due to the large proportion of Chinese patients (n=37), we grouped other Asians into one entity (n=54) for statistical comparison among Chinese, other Asians, and Whites (n=346). Chinese subjects had significantly lower body mass index (BMI) (p=0.001) and had the lowest proportion of living donors (p>0.001). Patient survival was highest in our Chinese cohort (p>0.001)Discussion: Our study confirms outcome differences among Asian subgroups in kidney transplantation. Chinese demonstrate better patient survival at one year than Whites and non-Chinese Asians despite fewer live donors. Lower BMI scores may partly explain this. Larger, long-term studies are needed to elucidate outcome disparities among Asian subgroups

Download Full-text

P1641DONOR ACUTE KIDNEY INJURY HAS A DELETERIOUS IMPACT ON KIDNEY GRAFT SURVIVAL: THE DON-AKI STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1641 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Rémi Lenain ◽

Camille Prouteau ◽

Nicolas Chatauret ◽

Aurélie Deshayes ◽

Yohann Foucher ◽

...

Keyword(s):

Acute Kidney Injury ◽

Graft Survival ◽

Organ Procurement ◽

Graft Loss ◽

Kidney Injury ◽

Organ Shortage ◽

Kidney Graft ◽

Donor Kidney ◽

Recovery Group

Abstract Background and Aims Acute kidney injury (AKI) during organ procurement represents an important cause of discarded kidneys. In the context of organ shortage, the evaluation of such grafts is needed in order to enlarge the donor pool. Although many studies showed an increased risk of delayed graft function when donors present with AKI, long-term impact on graft survival remains controversial. A recent large US registry study concluded that AKI during organ procurement had no deleterious effect on graft survival. However the definition of AKI in this latter study is questionable. Indeed the donor baseline serum creatinine (SCr), according to KDIGO recommendations, is often not available. In this situation, the KDIGO guidelines suggest to estimate the baseline SCr using the MDRD equation, assuming a baseline glomerular filtration rate at 75 mL/min/1.73m? This method was applied in the present study to assess the impact of donor kidney failure on long term kidney allograft survival. Method We analyzed the French national allocation system CRISTAL (Agence de la Biomédecine) data of all the recipients who received a deceased donor kidney graft from 2006 to 2017. 26786 transplant patients from 14899 deceased kidney donors were included. The donors were categorized into four groups. Ongoing AKI at the time of kidney procurement: n=1880 (3373 transplantations, AKI group), AKI with total recovery (normal SCr) at the time of kidney procurement: n=1332 donors (2392 transplantations, recovery group), elevated SCr all along the procedure: n=952 donors (1745 transplantations, unclassified AKI/CKD group) and normal SCr all along the procedure: n=10735 donors (19276 transplantations, no-AKI group). The main outcome was death censored graft survival. Results 4458 graft losses occurred during the study period (648 in the AKI group, 411 in the recovery group, 297 in the unclassified AKI/CKD group and 3102 in the no-AKI group) after a median follow-up time of 5.7 years (3 - 8.9). Multivariate analysis showed a significant increase risk of graft loss for each group when compared to the no-AKI group: HR 1.18 (1.04-1.34), HR 1.15 (1.04-1.28) and HR 1.22 (1.12-1.34) for the unclassified AKI/CKD, recovery and AKI groups, respectively. Regarding the AKI group, the risk of graft loss increased according to the AKI stage (KDIGO 2012): HR 1.20 (1.08-1.32) for stage I AKI and HR 1.31 (1.13-1.53) for stage II-III AKI. Conclusion Donor AKI represents a significant risk factor of graft loss, independently of SCr at the time of procurement. Stage II-III AKI carries a higher risk than stage I AKI suggesting a “dose-effect”. However, considering organ shortage, further studies are required to better allocate these sub-optimal kidneys.

Download Full-text

MO926RAPID VS. LATE RE-TRANSPLANTATION FOR EARLY KIDNEY GRAFT LOSS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.005 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Diana Rodríguez Espinosa ◽

Jose Jesus Broseta Monzo ◽

Evelyn Hermida-Lama ◽

Elena Cuadrado ◽

Jimena Del Risco ◽

...

Keyword(s):

Graft Survival ◽

Graft Failure ◽

Patient Survival ◽

Statistical Significance ◽

Graft Loss ◽

Human Leukocyte ◽

Type I ◽

Kidney Graft ◽

Antibody Mediated Rejection ◽

Increased Risk

Abstract Background and Aims Early graft failure (EGL) is a devastating complication of kidney transplantation. Patients with EGL have an increased risk of mortality of up to twelve times compared to patients who received grafts that survive beyond 30 days. Moreover, they may have become sensitized to antigens from the failed graft and that human leukocyte antigen antibodies (anti-HLA), identified on single antigen bead assays, may not be reliable until several weeks after transplantation. Thus, if rapid re-transplantation occurs, there is no certainty regarding the recipient's immunological status. Hence, there could be an increased immunological risk with the consequent disturbance of the new graft's survival. Method We performed a retrospective single-center observational study in re-transplanted patients with EGL (defined as graft loss before 30 days from transplant) between January 1977 and November 2019 from our center to analyze the outcomes of rapid re-transplantation (occurred within 30 days of EGL) vs late re-transplantation (occurred beyond those 30 days). Results: T here were 82 re-transplants after EGL. The median overall patient survival after re-transplantation was 32 years. Eight patients died within the first year. Among the mortality causes, there were four septic shocks, one cardiogenic shock, one massive pulmonary thromboembolism, one myocardial infarction, and one unknown cause. When analyzed for periods, death censored graft survival was 89% at one and five years after re-transplantation. One graft was lost at eight days due to antibody-mediated rejection (AMR), while there was one death with a functioning graft three months after re-transplantation secondary to a pulmonary embolism. Seventy-three late re-transplants occurred. When analyzed for periods, death censored graft survival was 81% and 69% at one and five years after re-transplantation, respectively. The median patient survival after late re-transplantation was 32 years. There were fewer deaths after rapid re-transplantation than late re-transplantation, but given the small number of cases in the former, this difference did not reach statistical significance (p = 0.3). There was no association between the timing of re-transplantation and an increased risk of graft failure (HR 0.30 [0.04 – 2.2]). While four rapid re-transplants did not share any incompatibilities between donors, four did share at least one HLA type I incompatibility, and one shared an incompatibility of HLA class I and class II. There were no T-cell mediated rejections (TCMR), and there was only one AMR in the rapid rapid re-transplantation group, whereas there were six TCMRs and fifteen AMRs in the late re-transplantation group (p = 0.03 and p = 0.4, respectively). Conclusion Rapid re-transplantation appears to be safe and does not entail increased rejection risk, nor it diminishes long-term graft survival when compared to late re-transplantation.

Download Full-text

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Lupus ◽

10.1177/09612033211028663 ◽

2021 ◽

pp. 096120332110286

Author(s):

Joaquín Rodelo ◽

Luis Alonso González ◽

José Ustáriz ◽

Silvia Matera ◽

Keylis Pérez ◽

...

Keyword(s):

Kidney Transplantation ◽

Renal Transplant ◽

Lupus Nephritis ◽

Graft Survival ◽

Patient Survival ◽

Graft Loss ◽

Single Center ◽

Increased Risk ◽

Recipient Age ◽

One Year

Objective We assessed patient and graft outcomes and prognostic factors in kidney transplantation in patients with end-stage kidney disease (ESKD) secondary to lupus nephritis (LN) undergoing kidney transplantation from August 1977 to December 2014 in a Latin American single center. Methods The primary endpoint was patient survival, and the secondary endpoints were death-censored graft survival for the first renal transplant and the rate of recurrent LN (RLN). Kaplan–Meier method was used for survival analysis. Factors predicting patient and death-censored graft survivals were examined by Cox proportional-hazards regression analyses. Results 185 patients were retrospectively evaluated. Patient survival rates were 88% at one year, 82% at three years, 78% at five years, and 67% at ten years. Death-censored graft survival for the first renal transplant was 93% at one year, 89% at three years, 87% at five years, and 80% at ten years. RLN was diagnosed in 2 patients (1.08%), but no graft was lost because of RLN. Thirty-nine (21.1%) patients died, and 65 (35.1%) patients experienced graft loss during the follow-up. By multivariable analyses, older recipient age and 1-month posttransplantation eGFR <45 ml/min/1.73m2 were associated with lower patient survival and an increased risk of graft loss, while induction immunosuppressive therapy exerted a protective effect on patients’ survival. In the subgroup of patients in whom disease activity was measured at the time of transplantation, a higher SLEDAI score was also associated with lower patient survival and an increased risk of graft loss. Conclusion In a mostly Mestizo population, kidney transplantation is an excellent therapeutic alternative in LN patients with ESKD. Older recipient age, an eGFR <45 ml/min/1.73m2 at one month posttransplantation, and disease activity at the time of transplantation are predictive of a lower patient and death-censored graft survival, while induction immunosuppressive therapy has a protective effect on patient survival. RLN is rare and does not influence the risk of graft loss.

Download Full-text

Tumor necrosis factor-α gene polymorphism is associated with short- and long-term kidney allograft outcomes.

10.1101/2021.07.28.21261294 ◽

2021 ◽

Author(s):

Felix Poppelaars ◽

Mariana Gaya da Costa ◽

Bernardo Faria ◽

Siawosh K. Eskandari ◽

Marc A. Seelen ◽

...

Keyword(s):

Kidney Transplantation ◽

Tumor Necrosis Factor ◽

Graft Survival ◽

Tumor Necrosis ◽

Graft Loss ◽

Tnf Alpha ◽

Kidney Graft ◽

Genotype Group ◽

Necrosis Factor

Introduction Kidney transplantation has excellent short-term results with current immunosuppression regimes, but long-term outcomes have barely improved. Hence, there is a need for new therapeutic options to increase long-term survival of kidney grafts. Drug development for transplantation has slowly plateaued, limiting progress while making drug repurposing an attractive alternative. We, therefore, investigated the impact of tumor necrosis factor-alpha (TNF-alpha) gene (TNF) polymorphisms on kidney graft survival. Methods We performed a prospective cohort study to assess the association of TNF polymorphisms (rs1800629 G>A and rs3093662 A>G) with primary non-function (PNF) and death-censored kidney allograft survival in 1,271 kidney transplant pairs from the University Medical Center Groningen in The Netherlands. Results The G-allele of the TNF rs3093662 polymorphism in donor kidneys was associated with a higher risk of PNF (odds ratio: 2.05; 95%-CI: 1.06-3.97; P = 0.032). Furthermore, the G-allele of this TNF rs3093662 polymorphism in the donor was also associated with worse 5-year, 10-year, and 15-year death-censored kidney graft survival (P<0.05). The cumulative incidence of graft loss was 15.9% in the reference AA-genotype group and 25.2% in the AG/GG-genotype group, respectively. In multivariable analysis, the association between the TNF rs3093662 polymorphism in the donor and 15-year death-censored kidney graft survival remained significant (hazard ratio: 1.51; 95%-CI: 1.05-2.19, P = 0.028). Conclusion Kidney allografts possessing a high-producing TNF polymorphism have a greater risk of immediate and late graft loss. Our study adds to a growing body of literature indicating the potential of TNF-alpha blockade in improving kidney transplantation outcomes.

Download Full-text

Kidney transplantation in the extremely elderly from extremely aged deceased donors: a kidney for each age

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz293 ◽

2020 ◽

Vol 35 (4) ◽

pp. 687-696

Author(s):

Jimena Cabrera ◽

Mario Fernández-Ruiz ◽

Hernando Trujillo ◽

Esther González ◽

María Molina ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Cox Regression ◽

Patient Survival ◽

Incidence Rates ◽

Allocation Policy ◽

Recipient Age ◽

Deceased Donors ◽

Stage Renal Disease ◽

End Stage

Abstract Background Advances in life expectancy have led to an increase in the number of elderly people with end-stage renal disease (ESRD). Scarce information is available on the outcomes of kidney transplantation (KT) in extremely elderly patients based on an allocation policy prioritizing donor–recipient age matching. Methods We included recipients ≥75 years that underwent KT from similarly aged deceased donors at our institution between 2002 and 2015. Determinants of death-censored graft and patient survival were assessed by Cox regression. Results We included 138 recipients with a median follow-up of 38.8 months. Median (interquartile range) age of recipients and donors was 77.5 (76.3–79.7) and 77.0 years (74.7–79.0), with 22.5% of donors ≥80 years. Primary graft non-function occurred in 8.0% (11/138) of patients. Cumulative incidence rates for post-transplant infection and biopsy-proven acute rejection (BPAR) were 70.3% (97/138) and 15.2% (21/138), respectively. One- and 5-year patient survival were 82.1 and 60.1%, respectively, whereas the corresponding rates for death-censored graft survival were 95.6 and 93.1%. Infection was the leading cause of death (46.0% of fatal cases). The occurrence of BPAR was associated with lower 1-year patient survival [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.64–10.82; P = 0.003]. Diabetic nephropathy was the only factor predicting 5-year death-censored graft survival (HR = 4.82, 95% CI 1.08–21.56; P = 0.040). Conclusions ESRD patients ≥75 years can access KT and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival.

Download Full-text