Background: Despite a significant shortage of kidneys for transplantation in the US, kidneys from older deceased donors are infrequently transplanted. This is primarily over concern of graft quality and transplant durability.
Methods: The US national transplant database (2000-2018) was assessed for deceased donor kidney transplant patient and graft survival, graft durability and stratified by donor age (<65 years>), Kidney Donor Profile Index (KDPI) and estimated glomerual filtration rate (GFR) one year post-transplantation (eGFR-1) were calculated.
Findings: Recipients of kidneys transplanted from deceased donors >65 years had a lower eGFR-1, (median 39 ml/min) than recipients of younger donor kidneys (median 54 ml/min). However, death-censored graft survival, stratified by eGFR-1, demonstrated similar survival, irrespective of donor age or KDPI. The durability of kidney survival decreases as the achieved eGFR-1 declines. KDPI has a poor association with eGFR-1 and lesser for graft durability. While recipients of kidneys > 65 years had a higher one year mortality than younger kidney recipients, recipients of kidneys > 65 years and an eGFR-1 <30 ml/min, had a lower survival than an untransplanted waitlist cohort (p<0.001).
Interpretation: The durability of kidney graft survival after transplantation was associated with the amount of kidney function gained through the transplant (eGFR-1) and the rate of graft loss (return to dialysis) was not significantly associated with donor age. 24.9% of recipients of older donor kidneys failed to achieve sufficient eGFR-1 providing a transplant survival benefit. While there is significant benefit from transplanting older kidneys, better decision-making tools are required to avoid transplanting kidneys that provide insufficient renal function.
Funding: None.
Keywords: AUC, area under curve; Age; CI, Confidence Interval; CKD, chronic kidney disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration Equation; CPRA, calculated panel-reactive antibody; DCD, donation after circulatory death; Donation; ESRD, end stage renal disease; Glomerular filtration rate (GFR); HHS, Department of Health and Human Services of the US government; HRSA, Health Resources and Services Administration, Agency within HHS; KDIGO, Kidney Disease Improving Global Outcomes; KDPI, kidney donor profile index; KDRI, kidney donor risk index; OPTN, Organ Procurement and Transplantation Network; Outcomes; Transplantation; eGFR, estimated glomerular filtration rate; eGFR-1, one year after transplantation.
© 2021 The Author(s).