Long-Term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age.

Autor:	Messina M; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and., Diena D; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and., Dellepiane S; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and., Guzzo G; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and., Lo Sardo L; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and., Fop F; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and., Segoloni GP; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and., Amoroso A; Immunogenetics and Transplant Biology Service, 'Città della Salute e della Scienza di Torino,' Department of Medical Sciences, University of Turin, Turin, Italy., Magistroni P; Immunogenetics and Transplant Biology Service, 'Città della Salute e della Scienza di Torino,' Department of Medical Sciences, University of Turin, Turin, Italy., Biancone L; Renal Transplant Center 'A. Vercellone,' Nephrology, Dialysis and Renal Transplant Division, 'Città della Salute e della Scienza di Torino' University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2017 Feb 07; Vol. 12 (2), pp. 323-331. Date of Electronic Publication: 2016 Dec 15.
DOI:	10.2215/CJN.06550616
Abstrakt:	Background and Objectives: Extended criteria donors represent nowadays a main resource for kidney transplantation, and recovery criteria are becoming increasingly inclusive. However, the limits of this approach are not clear as well as the effects of extreme donor ages on long-term kidney transplantation outcomes. To address these issues, we performed a retrospective study on extended criteria donor kidney transplantation. Design, Setting, Participants, & Measurements: In total, 647 consecutive extended criteria donor kidney transplantations performed over 11 years (2003-2013) were included. Donor, recipient, and procedural variables were classified according to donor age decades (group A, 50-59 years old [n=91]; group B, 60-69 years old [n=264]; group C, 70-79 years old [n=265]; and group D, ≥80 years old [n=27]). Organs were allocated in single- or dual-kidney transplantation after a multistep evaluation including clinical and histologic criteria. Long-term outcomes and main adverse events were analyzed among age groups and in either single- or dual-kidney transplantation. Kidney discard rate incidence and causes were evaluated. Results: Median follow-up was 4.9 years (25th; 75th percentiles: 2.7; 7.6 years); patient and graft survival were comparable among age groups (5-year patient survival: group A, 87.8%; group B, 88.1%; group C, 88.0%; and group D, 90.1%; P=0.77; graft survival: group A, 74.0%; group B, 74.2%; group C, 75.2%; and group D, 65.9%; P=0.62) and between dual-kidney transplantation and single-kidney transplantation except for group D, with a better survival for dual-kidney transplantation (P=0.04). No difference was found analyzing complications incidence or graft function over time. Kidney discard rate was similar in groups A, B, and C (15.4%, 17.7%, and 20.1%, respectively) and increased in group D (48.2%; odds ratio, 5.1 with A as the reference group; 95% confidence interval, 2.96 to 8.79). Conclusions: Discard rate and long-term outcomes are similar among extended criteria donor kidney transplantation from donors ages 50-79 years old. Conversely, discard rate was strikingly higher among kidneys from octogenarian donors, but appropriate selection provides comparable long-term outcomes, with better graft survival for dual-kidney transplantation. (Copyright © 2017 by the American Society of Nephrology.)
Databáze:	MEDLINE
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