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Comparative Study
. 2020 May 22:11:954.
doi: 10.3389/fimmu.2020.00954. eCollection 2020.

Impact of Combinations of Donor and Recipient Ages and Other Factors on Kidney Graft Outcomes

Maria Gerbase-DeLima  1 , Renato de Marco  1 , Franscisco Monteiro  2 , Hélio Tedesco-Silva  3 , José O Medina-Pestana  3   4 , Karina L Mine  1
Affiliations
Comparative Study

Impact of Combinations of Donor and Recipient Ages and Other Factors on Kidney Graft Outcomes

Maria Gerbase-DeLima et al. Front Immunol. .

Abstract

As the availability of kidneys for transplantation continues to be outpaced by its growing demand, there has been an increasing utilization of older deceased donors in the last decades. Considering that definition of factors that influence deceased donor kidney transplant outcomes is important for allocation policies, as well as for individualization of post-transplant care, the purpose of this study was determine the risks for death censored graft survival and for patient survival conferred by older age of the donor in the context of the age of the recipient and of risk factors for graft and/or patient survival. The investigation was conducted in a single-center cohort of 5,359 consecutive first kidney transplants with adult deceased donors performed on non-prioritized adult recipients from January 1, 2002, to December 31, 2017. Death censored graft survival and patient survival were lower in older donors, whereas graft survival was higher and patient survival was lower in old recipients. The analyses of combinations of donor and recipient ages showed that death censored graft survival was lower in younger recipients in transplants from 18 to 59-year old donors, with standard or extended criteria, but no difference in graft survival was observed between younger and older recipients when the donor was ≥ 60-year old. Patient survival was higher in younger recipients in transplants with younger or older donors. Two to six HLA-A,B,DR mismatches, when compared to 0-1 MM, conferred risk for death-censored graft survival only in transplants from younger donors to younger recipients. Pre-transplant diabetes conferred risk for patient survival only in 50-59-year old recipients, irrespectively, of the age of the donor. Time on dialysis ≥ 10 years was a risk factor for patient survival in transplants with all donor-recipient age combinations, except in recipients with ≥ 60 years that received a kidney from an 18-49-year old donor. In conclusion, the results obtained in this study underline the importance of analyzing the impact of the age of the donor taking into consideration different scenarios.

Keywords: death censored graft survival; donor age; kidney transplantation; patient survival; recipient age.

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Figures

Figure 1
Figure 1
Influence of donor age on death censored graft survival (A) and patient survival (B) during the first 5 post-transplant years. Donors were divided into four groups, 18–49 years, 50–59 years with standard criteria (SCD), 50–59 years with extended criteria (ECD) and with 60 or more years. ECD were defined according to the United Network for Organ Sharing definition. Kaplan-Meier curves were compared with multivariate Cox regression analysis.
Figure 2
Figure 2
Influence of recipient age on death censored graft survival (A) and patient survival (B) during the first 5 post-transplant years. Recipients were divided into three groups, 18–49 years, 50–59 years and with 60 or more years. Kaplan-Meier curves were compared with multivariate Cox regression analysis.
Figure 3
Figure 3
Influence of the combination of donor and recipient ages on death censored graft survival (A) and patient survival (B) during the first 5 post-transplant years. (A) Based on previous results, in death censored graft survival analysis, donors were divided into three groups: 18–59 years with standard criteria (SCD), 50–59 years with extended criteria (ECD) and ≥ 60 years; recipients were divided in two groups: 18–49 years and ≥ 50 years. In patient survival analyses (B), donors were divided into two groups, 18–49 years and ≥ 50 years, and recipients in three groups, 18–49 years, 50–59 years and ≥ 60 years. ECD were defined according to the United Network for Organ Sharing definition. Kaplan-Meier curves were compared with the log rank test.
Figure 4
Figure 4
Influence of the combination of recipient age and HLA-A, -B, -DR mismatches on death censored graft survival during the first 5 post-transplant years, stratified by donor age, (A) 18–59 years with standard criteria (SCD), (B) 50–59 years with extended criteria (ECD) and (C) ≥ 60 years. ECD were defined according to the United Network for Organ Sharing definition. Kaplan-Meier curves were compared with the log rank test.
Figure 5
Figure 5
Influence of the combination of recipient age and pre-transplant diabetes on patient survival during the first 5 post-transplant years, stratified by donor age: (A) 18-49 years, (B) ≥ 50 years. Kaplan-Meier curves were compared with the log rank test.
Figure 6
Figure 6
Influence of the combination of recipient age and time on dialysis on patient survival during the first 5 post-transplant years, stratified by donor age: (A) 18–49 years, (B) ≥ 50 years. Kaplan-Meier curves were compared with the log rank test.
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References

    1. Jay CL, Washburn K, Dean PG, Helmick RA, Pugh JA, Stegall MD. Survival benefit in older patients associated with earlier transplant with high KDPI kidneys. Transplantation. (2017) 101:867–72. 10.1097/TP.0000000000001405 - DOI - PMC - PubMed
    1. Dreyer GJ, Hemke AC, Reinders ME, de Fijter JW. Transplanting the elderly: Balancing aging with histocompatibility. Transplant Rev. (2015) 29:205–11. 10.1016/j.trre.2015.08.003 - DOI - PubMed
    1. Coemans M, Süsal C, Döhler B, Anglicheau D, Giral M, Bestard O, et al. . Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015. Kidney Int. (2018) 94:964–73. 10.1016/j.kint.2018.05.018 - DOI - PubMed
    1. Echterdiek F, Schwenger V, Döhler B, Latus J, Kitterer D, Heemann U, et al. . Kidneys from elderly deceased donors- Is 70 the new 60? Front Immunol. (2019) 10:2701. 10.3389/fimmu.2019.02701 - DOI - PMC - PubMed
    1. ET Eurotransplant Statistics Report Library. Available online at: http://statistics.eurotransplant.org/ (accessed March, 2020).

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