More Kidneys Available for Transplant

…This approach may help to expand the donor-organ pool for kidney transplantation.

Entire abstract follows:

Long-Term Outcome of Renal Transplantation from Older Donors

Giuseppe Remuzzi, M.D., Paolo Cravedi, M.D., Annalisa Perna, Stat.Sci.D., Borislav D. Dimitrov, M.D., M.Sc., Marta Turturro, Biol.Sci.D., Giuseppe Locatelli, M.D., Paolo Rigotti, M.D., Nicola Baldan, M.D., Marco Beatini, M.D., Umberto Valente, M.D., Mario Scalamogna, M.D., Piero Ruggenenti, M.D., for the Dual Kidney Transplant Group

Editorial by Delmonico, F. L.

ABSTRACT

Background Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic characteristics before implantation would positively influence long-term outcome.

Methods In a prospective cohort study, we assessed outcomes among 62 patients who received one or two histologically evaluated kidneys from donors older than 60 years of age. These outcomes were compared with outcomes among 248 matched recipients of single kidney grafts that had not been histologically evaluated and were either from donors 60 years of age or younger (124 positive-reference recipients who, according to available data, were expected to have an optimal outcome) or from those older than 60 years (124 negative-reference recipients, expected to have a worse outcome). The primary end point was graft survival.

Results During a median period of 23 months, 4 recipients (6 percent) of histologically evaluated kidneys progressed to dialysis, as compared with 7 positive-reference recipients (6 percent) and 29 negative-reference recipients (23 percent). Graft survival in recipients of histologically evaluated kidneys did not differ significantly from that of grafts in positive-reference recipients but was superior to that of grafts in negative-reference recipients (hazard ratio for graft failure in the negative-reference recipients relative to the recipients of histologically evaluated kidneys, 3.68; 95 percent confidence interval, 1.29 to 10.52; P=0.02). The performance of preimplantation histologic evaluation predicted better survival both in the whole study group (P=0.02) and among recipients of kidneys from older donors (P=0.01).

Conclusions The long-term survival of single or dual kidney grafts from donors older than 60 years of age is excellent, provided that the grafts are evaluated histologically before implantation. This approach may help to expand the donor-organ pool for kidney transplantation. (Hooray!!)

Anyone have access to the entire article?

QUOTED FROM A NEWS SOURCE:
In an editorial that accompanied the study, Francis L. Delmonico, M.D., president of the Organ Procurement and Transplantation Network, and James F. Burdick, M.D., director of the Division of Transplantation of the Health Human Services Administration, acknowledged that there will be “little enthusiasm for transplanting a 60-year old kidney into a 30-year-old recipient,” but added that older recipients will benefit from “expanded-criteria donors.”
UNQUOTE

…and probably little enthusiasm by under 60 year old recipients for older kidneys. Once you get a transplant from the waiting list, you start back at square one if and when it fails. With the extra antibodies at that point, it could mean a very long wait the second time around. Under those circumstances, one has to wonder if it wouldn’t be better to continue waiting while on daily hemo.

Pierre

I agree Pierre, there may be little value in using a 65 year old kidney in a someone very young. BUT, if the recipient is over 50 or 60 and otherwise healthy, as many PKD patients are, this may be very good news. Other than the kidney failure many PKD patients have a life expectancy of more than 80 or 90 years. They might be greatly helped by getting one of the older kidneys, especially if it is an excellent match w/ a very low expectation of rejection. If it is a cadaver kidney which would currently be thrown away, the older patients ought to have the opportunity to make the choice and not have it made for them. (JMO) :slight_smile:

That being said, my husband, at age 63, has already decided, for many reasons not to even try a transplant. Of course, if he encounters many problems w/ dialysis he may change his mind, and it does give me reassurance to know that the pool of available kidneys has increased IF he ever has to make that choice.

Oh, I certainly agree it has the potential to increase the number of available kidneys, and a person over 65 might accept one - and thereby move younger people up on the list a bit.

Another newish idea along the same lines is that of “marginal kidneys”. I’ve been on the waiting list for over 3 years now. I hope I don’t have to make the decision to accept or reject a marginal kidney. I’m pretty sure I would choose to keeping waiting on home hemo, though.

What transplant coordinators will tell you if they are being honest is that the days of people getting multiple kidney transplants, 2, 3 or 4 times in their lifetime are past. Nowadays, most people will only get one kick at the cat. To me, older or marginal kidneys sound like a great idea for the system (especially in a for-profit system), but a very poor idea for the individual.

Sorry, I don’t mean to be a contrarian on purpose, but that’s the way I feel about it :slight_smile:

Pierre

:lol: I don’t think you’re being contrary. I agree that the only way using older and marginal kidneys may help younger people is that it may get older people off the waiting list.

As far as “getting one kick at the cat” in the future, I agree. As methods evolve for making better matches, and anti-rejection drugs advance, most people may need only one transplant. As dialysis/artificial kidneys become simpler, smaller, and more efficient, they will remain the best choice for many who do not want to have a transplant, and even become the choice for some who years earlier would have wanted a transplant instead.

Another option that reduces the waiting time to get a kidney transplant is living donation. The number of living donors is increasing faster than the number of kidneys donated by deceased donors. In fact today about 44% of donations come from live donors.

Although in the “old days” living donors had to be related to the recipient, today living donors can be spouses, friends, acquaintances, or even unknown “altruistic donors.” Read about all the different types of living donations, including related, non-related, non-directed, paired exchange, living donor/deceased exchange, blood type incompatible, and positive crossmatch that are possible on http://www.transplantliving.org/livingdonation/default.aspx

Beth, take that period at the end off… :lol:

http://www.transplantliving.org/livingdonation/default.aspx