Abstract
Background and Aims
Although outcomes of solid organ transplantation are excellent in the modern era, the scarcity of donor organs relative to patients on the waiting list has remained a limitation of the field. One of the most doubtful points in donor evaluation is donor age and its impact on graft outcome. The kidney, like most organs, undergoes a progressive decline in function with advancing age. Aim: our aim is to evaluate the combined age of recipient and donor on graft and patient survival.
Method
This retrospective cohort study was held in Mansoura Urology and Nephrology Center, Mansoura University, Egypt. The study included all kidney transplant recipients received allo-renal transplantation in the center during the period between March 1976 and December 2019 (3068 KTRs). The patients were divided into 4 main groups according to recipient and donor age: Group I: Kidney transplant recipients < 40 years from donors < 40 years (1665 KTrs), Group II: Kidney transplant recipients < 40 years from donors ≥ 40 years (932 KTrs), Group III: Kidney transplant recipients ≥ 40 years from donors < 40 years (320 KTrs) and Group IV: Kidney transplant recipients ≥40 years from donors ≥ 40 years (151 KTrs).
Results
73.6% of the included recipients were males while 55% of donors were females. Transplantation from related donors is the rule in all groups. Incidence of hypertension was more frequent with old recipients in group III and IV. About 95% of the patients received hemodialysis before transplantation for about 1.6±0.3 years.
As regard immunosuppression, steroid-based and cyclosporine-based regimen was used more in group III (p value: 0.0001, 0.0001 respectively). While, tacrolimus-based regimen was used frequently in group IV. Azathioprine use was higher among group III while MMF use was higher in group IV.
Incidence of acute rejection and chronic rejection was higher in group I and of lower incidence in group VI. Incidence of post-transplant hypertension, diabetes and hepatic impairment occurred more frequently in group III and lower frequency in group I. Incidence of malignancy was higher in group III (p value: 0.0001).
Serum creatinine at the end of the year for 5 years after transplantation was higher in group IV and lower in group I with statistical significant difference. Overall, 5, 10 and 15 years graft survival was better in group I and worse in group III (p value: 0.012) (figure 1). 5, 10 and 15 years patient survival was higher in group II and lower in group IV (p value: 0.013) (figure 2).
Conclusion
Combined donor-recipient age affects both graft function and transplantation complications. Young donor to young recipient transplantation was associated with higher incidence of rejection but lower incidence of post-transplant medical complications. Young donor to old recipient transplantation was associated with higher incidence of post-transplant medical complications and malignancy. Old donor to old recipient transplantation was associated with the lowest incidence of rejection.
Economic change and graft outcome in kidney transplant recipients: a nationwide study of Korea