NIV Congres
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Increased mortality in elderly recipients of non heart-beating kidneys
Berger, S.P., Roodnat, J.I., IJzermans, J.N.M., Betjes, M.G.H., Weimar, W. W.
Categorie(ën):
Background In the Netherlands a considerable number of non heart-beating kidneys (NHB) are transplanted to elderly recipients following the European Senior Program allocation principles. However, there is sparse data on the outcome of elderly recipients receiving NHB kidneys from elderly recipients.
Methods We examined the outcomes of NHB versus heart-beating (HB) kidney transplantation in recipients aged either above or below 65 years transplanted between 2000 and 2011 at our center.
Results In the studied period a total of 519 deceased donor transplantations were performed. The recipients below 65 years received 248 HB and 154 NHB kidneys while 89 HB and 28 NHB procedures were performed in recipients above 65 years. No significant difference for death censored graft survival was detected when HB kidneys were compared with of NHB kidneys in both age groups. When examining death with a functioning graft, survival was comparable in recipients below 65 years who received either NHB or HB kidneys. However, in recipients above 65 years patient survival was markedly lower after NHB transplantation compared to HB transplantation (median survival 3.6 vs 8.4 years, P=0.006). In a limited multivariate analysis for patient death (including patient and donor age, delayed graft function, rejection and donor category as covariates), the presence of delayed graft function was an independent predictor of death with a functioning graft in the elderly patient group (HR 3.2, CI 1.3-8.1), while delayed graft function was not associated with survival in younger patients.
Conclusions This small study points towards the important role of organ quality in older recipients. The outcome of NHB transplantation may be markedly influenced by recipient age. Our findings suggest that untoward effects of delayed graft function may play a role in the increased mortality after NHB transplantation in elderly recipients in our cohort. Further studies on the interaction of donor quality with acceptor age are warranted. Additionally our findings emphasize the importance of thoughtful care for elderly patients experiencing delayed graft function after transplantation