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Kidney transplantation from elderly donors (> 70 years): a systematic review

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Abstract

Purpose

The incidence of kidney transplants from elderly donors over 70 years of age has increased significantly over the past 10 years to reach 20% of available kidney graft in some European countries. However, there is little data available on the outcomes of transplants from these donors. We performed a systematic review to evaluate the outcomes of transplantation from donors over 70 years of age.

Methods

A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting outcomes on kidney transplants from donors over 70 years. Due to the heterogeneity of the studies, a meta-analysis could not be performed.

Results

A total of 29,765 patients in 27 studies were included. The mean donors age was 74.79 years, and proportion of kidney graft from women was 53.54%. The estimated 1- and 5-year kidney death-censored graft survivals from donors > 70 years old were, respectively, 85.95 and 80.27%, and the patient survivals were 90.88 and 71.29%. The occurrence of delayed graft function was 41.75%, and primary non-function was 4.67%. Estimated graft function at 1 and 5 years was 36 and 38 mL/min/1.73 m2. Paucity data were available on post-operative complications.

Conclusions

Elderly donors appear to be a reliable source of grafts. However, these transplants are associated with a high rate of delayed graft function without repercussion on long-term graft survival. Allocation strategy to elderly recipients is the main factor of decreased recipient survival.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

DGF:

Delayed graft function

eGFR:

Estimated glomerular filtration rate

ECD:

Expanded criteria donor

KT:

Kidney transplantation

PNF:

Primary non-function

RoB:

Risk of bias

References

  1. Laupacis A, Keown P, Pus N, Krueger H, Ferguson B, Wong C et al (1996) A study of the quality of life and cost-utility of renal transplantation. Kidney Int 50(1):235–242. https://doi.org/10.1038/ki.1996.307

    Article  CAS  PubMed  Google Scholar 

  2. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341(23):1725–1730. https://doi.org/10.1056/NEJM199912023412303

    Article  CAS  PubMed  Google Scholar 

  3. Cohen B, Smits JM, Haase B, Persijn G, Vanrenterghem Y, Frei U (2005) Expanding the donor pool to increase renal transplantation. Nephrol Dial Transpl 20(1):34–41. https://doi.org/10.1093/ndt/gfh506. (Epub 2004 Nov 2)

    Article  Google Scholar 

  4. Rao PS, Ojo A (2009) The alphabet soup of kidney transplantation: SCD, DCD, ECD–fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol 4(11):1827–1831. https://doi.org/10.2215/CJN.02270409

    Article  PubMed  Google Scholar 

  5. Pascual J, Zamora J, Pirsch JD (2008) A systematic review of kidney transplantation from expanded criteria donors. Am J Kidney Dis 52(3):553–586. https://doi.org/10.1053/j.ajkd.2008.06.005

    Article  PubMed  Google Scholar 

  6. Querard AH, Foucher Y, Combescure C, Dantan E, Larmet D, Lorent M et al (2016) Comparison of survival outcomes between expanded criteria donor and standard criteria donor kidney transplant recipients: a systematic review and meta-analysis. Transpl Int 29(4):403–415. https://doi.org/10.1111/tri.12736

    Article  PubMed  Google Scholar 

  7. Ojo AO, Hanson JA, Meier-Kriesche HU, Okechukwu CN, Wolfe RA, Leichtman AB et al (2001) Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 12(3):589–597. https://doi.org/10.1681/ASN.V123589

    Article  PubMed  Google Scholar 

  8. Merion RM, Ashby VB, Wolfe RA, Distant DA, Hulbert-Shearon TE, Metzger RA et al (2005) Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA 294(21):2726–2733. https://doi.org/10.1001/jama.294.21.2726

    Article  CAS  PubMed  Google Scholar 

  9. Eklou ND, Jänigen BM, Pisarski P, Walz G, Schneider J (2022) Evaluation of deceased donor kidney transplantation in the Eurotransplant senior program in comparison to standard allocation. Ann Transpl 27:e936514. https://doi.org/10.12659/AOT.936514

    Article  Google Scholar 

  10. Agence de la biomédecine. Le rapport médical et scientifique de l’Agence de la biomédecine 2017 [online]. 2017 [Cited the 30 June 2022]. Available on: https://www.agence-biomedecine.fr/annexes/bilan2017/donnees/organes/06-rein/synthese.htm

  11. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  13. ROBINS-E Development Group (Higgins J, Morgan R, Rooney A, Taylor K, Thayer K, Silva R, et al. Risk Of Bias In Non-randomized Studies - of Exposure (ROBINS-E). Launch version, 1 June 2022. Available from: https://www.riskofbias.info/welcome/robins-e-tool

  14. Reeves BC, Deeks JJ, Higgins JP (2008) 13 Including nonrandomized studies. Cochrane Handb Syst Rev Interv 1:391

    Google Scholar 

  15. Organ Procurement & Transplantation Network. Deceased Donors Recovered in the US by Donor Age [Online]. 2022 [Cited the 30 June 2022]. Available on: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#

  16. Maanaoui M, Provôt F, Bouyé S, Lionet A, Lenain R, Fages V et al (2021) Impaired renal function before kidney procurement has a deleterious impact on allograft survival in very old deceased kidney donors. Sci Rep 11(1):12226. https://doi.org/10.1038/s41598-021-91843-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Messina M, Diena D, Dellepiane S, Guzzo G, Lo Sardo L, Fop F et al (2017) Long-term outcomes and discard rate of kidneys by decade of extended criteria donor age. Clin J Am Soc Nephrol 12(2):323–331. https://doi.org/10.2215/CJN.06550616

    Article  PubMed  Google Scholar 

  18. Ruggenenti P, Silvestre C, Boschiero L, Rota G, Furian L, Perna A et al (2017) Long-term outcome of renal transplantation from octogenarian donors: a multicenter controlled study. Am J Transplant 17(12):3159–3171. https://doi.org/10.1111/ajt.14459

    Article  PubMed  Google Scholar 

  19. Gallinat A, Feldkamp T, Schaffer R, Radünz S, Treckmann JW, Minor T et al (2011) Single-center experience with kidney transplantation using deceased donors older than 75 years. Transplantation 92(1):76–81. https://doi.org/10.1097/TP.0b013e31821d2687

    Article  PubMed  Google Scholar 

  20. Ibrahim M, Greenhall GHB, Summers DM, Mumford L, Johnson R, Baker RJ et al (2020) Utilization and outcomes of single and dual kidney transplants from older deceased donors in the United Kingdom. Clin J Am Soc Nephrol 15(9):1320–1329. https://doi.org/10.2215/CJN.02060220

    Article  PubMed  PubMed Central  Google Scholar 

  21. Laftavi MR, Stephan R, Feng L, Said M, Kohli R, Dayton M et al (2011) Dual kidney transplants from very old or very young donors: long-term outcomes and complications. Transplant Proc 43(2):507–511. https://doi.org/10.1016/j.transproceed.2011.01.038

    Article  CAS  PubMed  Google Scholar 

  22. De Serres SA, Caumartin Y, Noël R, Lachance JG, Côté I, Naud A et al (2010) Dual-kidney transplants as an alternative for very marginal donors: long-term follow-up in 63 patients. Transplantation 90(10):1125–1130. https://doi.org/10.1097/TP.0b013e3181f8f2b8

    Article  PubMed  Google Scholar 

  23. Casati C, Colombo VG, Perrino M, Rossetti OM, Querques M, Giacomoni A et al (2018) Renal transplants from older deceased donors: use of preimplantation biopsy and differential allocation to dual or single kidney transplant according to histological score has no advantages over allocation to single kidney transplant by simple clinical indication. J Transplant 16(2018):4141756. https://doi.org/10.1155/2018/4141756

    Article  Google Scholar 

  24. Saito M, Inoue T, Narita S, Numakura K, Kanda S, Chiba S et al (2019) Kidneys received from living donors over 70 years of age: are those feasible as the grafts? Eur Urol Sup. https://doi.org/10.1016/S1569-9056(19)31194-7

    Article  Google Scholar 

  25. Kuhn C, Lang BM, Lörcher S, Karolin A, Binet I, Beldi G et al (2021) Outcome of kidney transplantation from very senior donors in Switzerland-a national cohort study. Transpl Int 34(4):689–699. https://doi.org/10.1111/tri.13836

    Article  PubMed  Google Scholar 

  26. Echterdiek F, Latus J, Döhler B, Schwenger V, Süsal C (2021) Impact of HLA compatibility in recipients of kidneys from expanded criteria donors: a Collaborative Transplant Study Report. Int J Immunogenet 48(2):201–210. https://doi.org/10.1111/iji.12512

    Article  CAS  PubMed  Google Scholar 

  27. Arcos E, Pérez-Sáez MJ, Comas J, Lloveras J, Tort J, Pascual J, Catalan Renal Registry* (2020) Assessing the limits in kidney transplantation: use of extremely elderly donors and outcomes in elderly recipients. Transplantation 104(1):176–183

    Article  PubMed  Google Scholar 

  28. Echterdiek F, Schwenger V, Döhler B, Latus J, Kitterer D, Heemann U et al (2019) Kidneys from elderly deceased donors-is 70 the new 60? Front Immunol 27(10):2701. https://doi.org/10.3389/fimmu.2019.02701

    Article  CAS  Google Scholar 

  29. Casati C, Colombo VG, Perrino M, Rossetti OM, Querques M, Giacomoni A et al (2018) Renal Transplants from older deceased donors: use of preimplantation biopsy and differential allocation to dual or single kidney transplant according to histological score has no advantages over allocation to single kidney transplant by simple clinical indication. J Transpl 16(2018):4141756. https://doi.org/10.1155/2018/4141756

    Article  Google Scholar 

  30. Ferreira E, Costa J, Romãozinho C, Santos L, Macário F, Bastos C et al (2017) Long-Term outcomes of kidney transplantation from expanded-criteria deceased donors: a single-center experience. Transpl Proc 49(4):770–776. https://doi.org/10.1016/j.transproceed.2017.01.051

    Article  CAS  Google Scholar 

  31. Adekoya AO, Halawa A (2016) Kidneys from deceased elderly donors: factors associated with adverse outcomes. Exp Clin Transpl 14(1):32–37

    Google Scholar 

  32. Pérez-Sáez MJ, Arcos E, Comas J, Crespo M, Lloveras J, Pascual J, Catalan Renal Registry (2016) Survival benefit from kidney transplantation using kidneys from deceased donors aged ≥75 years: a time-dependent analysis. Am J Transpl 16(9):2724–33. https://doi.org/10.1111/ajt.13800

    Article  Google Scholar 

  33. Khalid U, Jameel M, Sabah T, Szabo L, Ilham MA, Chavez R et al (2019) Older donation after circulatory death kidneys for older recipients: a single-center experience. Transpl Proc 51(3):701–706. https://doi.org/10.1016/j.transproceed.2019.01.081

    Article  CAS  Google Scholar 

  34. Mallon DH, Riddiough GE, Summers DM, Butler AJ, Callaghan CJ, Bradbury LL et al (2015) Successful transplantation of kidneys from elderly circulatory death donors by using microscopic and macroscopic characteristics to guide single or dual implantation. Am J Transpl 15(11):2931–2939. https://doi.org/10.1111/ajt.13349

    Article  CAS  Google Scholar 

  35. Englum BR, Schechter MA, Irish WD, Ravindra KV, Vikraman DS, Sanoff SL et al (2015) Outcomes in kidney transplant recipients from older living donors. Transplantation 99(2):309–315. https://doi.org/10.1097/TP.0000000000000607

    Article  PubMed  Google Scholar 

  36. Marconi L, Figueiredo A, Campos L, Nunes P, Roseiro A, Parada B et al (2013) Renal transplantation with donors older than 70 years: does age matter? Transpl Proc 45(3):1251–1254. https://doi.org/10.1016/j.transproceed.2013.02.024

    Article  CAS  Google Scholar 

  37. Machado S, Figueiredo N, Neves M, Macário F, Alves R, Mota A et al (2012) Kidney transplantation using donors over 70 years old: are the criteria for organ allocation too expanded? Transpl Proc 44(8):2289–2292. https://doi.org/10.1016/j.transproceed.2012.07.031

    Article  CAS  Google Scholar 

  38. Balachandran VP, Aull MJ, Charlton M, Afaneh C, Serur D, Leeser DB et al (2012) Kidneys from older living donors provide excellent intermediate-term outcomes after transplantation. Transplantation 94(5):499–505. https://doi.org/10.1097/TP.0b013e31825c5940

    Article  PubMed  Google Scholar 

  39. Berger JC, Muzaale AD, James N, Hoque M, Wang JM, Montgomery RA et al (2011) Living kidney donors ages 70 and older: recipient and donor outcomes. Clin J Am Soc Nephrol 6(12):2887–2893. https://doi.org/10.2215/CJN.04160511

    Article  PubMed  PubMed Central  Google Scholar 

  40. Galeano C, Marcén R, Jimenez S, Fernández Rodríguez A, Sosa H, Villafruela JJ et al (2010) Utilization of elderly kidney donors (>70 years) does not affect graft survival in the medium term. Transpl Proc 42(10):3935–3937. https://doi.org/10.1016/j.transproceed.2010.08.069

    Article  CAS  Google Scholar 

  41. Foss A, Heldal K, Scott H, Foss S, Leivestad T, Jørgensen PF et al (2009) Kidneys from deceased donors more than 75 years perform acceptably after transplantation. Transplantation 87(10):1437–1441. https://doi.org/10.1097/TP.0b013e3181a4ebd2

    Article  PubMed  Google Scholar 

  42. Gavela E, Pallardó LM, Avila A, Sancho A, Beltrán S, Kanter J et al (2009) Renal allografts from donors older than 70 years are useful for single transplantation. Transpl Proc 41(6):2047–9. https://doi.org/10.1016/j.transproceed.2009.05.024

    Article  CAS  Google Scholar 

  43. Giessing M, Fuller TF, Friedersdorff F, Deger S, Wille A, Neumayer HH et al (2009) Outcomes of transplanting deceased-donor kidneys between elderly donors and recipients. J Am Soc Nephrol 20(1):37–40. https://doi.org/10.1681/ASN.2008040423

    Article  PubMed  PubMed Central  Google Scholar 

  44. Collini A, Kalmar P, Dhamo A, Ruggieri G, Carmellini M (2009) Renal transplant from very old donors: how far can we go? Transplantation 87(12):1830–1836. https://doi.org/10.1097/TP.0b013e3181a6b4ff

    Article  PubMed  Google Scholar 

  45. Chavalitdhamrong D, Gill J, Takemoto S, Madhira BR, Cho YW, Shah T, Bunnapradist S (2008) Patient and graft outcomes from deceased kidney donors age 70 years and older: an analysis of the organ procurement transplant network/united network of organ sharing database. Transplantation 85(11):1573–1579. https://doi.org/10.1097/TP.0b013e31817059a1

    Article  PubMed  Google Scholar 

  46. Oppenheimer F, Aljama P, Asensio Peinado C, Bustamante Bustamante J et al (2004) The impact of donor age on the results of renal transplantation. Nephrol Dial Transpl. https://doi.org/10.1093/ndt/gfh1008

    Article  Google Scholar 

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Acknowledgements

Group name: EAU-Young Academic Urologist (YAU) group of Kidney Transplant.

Thomas Prudhomme, Romain Boissier, Vital Hevia, Ricardo Campi, Alessio Pecoraro, Angelo Territo.

Funding

None.

Author information

Author notes

  1. Benoit Mesnard and Angelo Territo have equally contributed to writing this article.

Authors and Affiliations

  1. Department of Urology, Nantes Université, CHU Nantes, Nantes, France

    Benoit Mesnard

  2. Uro-Oncology and Kidney Transplant Unit, Department of Urology at “Fundació Puigvert” Hospital, Autonoma University of Barcelona, Barcelona, Spain

    Angelo Territo

  3. Department of Urology, Florence University Hospital, Florence, Italy

    Riccardo Campi & Alessio Pecoraro

  4. Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain

    Vital Hevia

  5. Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Iulia Andras

  6. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy

    Alberto Piana

  7. Department of Urology, La Conception University Hospital, Marseille, France

    Romain Boissier

  8. Department of Urology and Kidney Transplantation, Toulouse University Hospital, TSA 50032 Rangueil Hospital, 31059, Toulouse Cedex 9, France

    Thomas Prudhomme

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  1. Benoit Mesnard
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Consortia

for the EAU-Young Academic Urologist (YAU) group of Kidney Transplantation

  • Thomas Prudhomme
  • , Romain Boissier
  • , Vital Hevia
  • , Alessio Pecoraro
  • , Thomas Prudhomme
  • , Romain Boissier
  • , Vital Hevia
  • , Ricardo Campi
  • , Angelo Territo
  • , Alessio Pecoraro
  •  & Angelo Territo

Contributions

BM, TP and AT were involved in protocol development, data collection, data analysis, manuscript writing. RC contributed to protocol development, manuscript editing, manuscript editing. IA and AP were involved in manuscript editing. AP, VH and RB contributed to protocol development, data analysis, manuscript editing. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Thomas Prudhomme.

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The authors declare that they have no conflict of interest.

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The protocol was submitted to PROSPERO (CRD42022337667).

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Not required. No individual data were used in this study.

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Mesnard, B., Territo, A., Campi, R. et al. Kidney transplantation from elderly donors (> 70 years): a systematic review. World J Urol 41, 695–707 (2023). https://doi.org/10.1007/s00345-023-04311-4

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