This is a retrospective study done at Sheffield Kidney Institute between March 1969 and 2009, including all kidney transplant from deceased donor > 60 years old.
The study aimed to explore transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above) at a single centre.
Graft and recipients’ survival are determined by the following factors: donor age, sex, sCr level, eGFR, and CIT.
Recipients’ factors: patient status, age, sex, comorbidities, Type of immunosuppressant used, number of acute rejection episodes, DGF, and eGFR at 3, 12, and 60 months after transplantation.
Donor age categorizes as follow;(60-64), (65-69), (and >70) years old.
Donor/Recipients factors; HLA MM, HLA-DR only MM, Total follow-up, Total duration of graft failure, Graft, and Recipient survival at 1, 3, 5, years’ post-transplant.
All rejections are registered and biopsy-based diagnosis.
The study showed:
Patient survival was at 1 year was 91.9%, At 3 yrs82.15, At 5 years 78.2% while graft survival At 1 years was 80.4%, At 3 years was 67.7%, At 5 years was 63.65.
Total duration of graft survival was significantly associated with donor age and serum Cr.
Use donor kidney with eGFR >60 had better survival than those with eGFR < 60.
Kidneys from donor’s age >70 had better cumulative survival rate.
Graft survival was found to be independent from donor age and so expanding criteria for donation as in the past donation from older age was unfavourable.
No significant association between donor age and other D/R variables
In contrast Opelz conclude that HLA MM had a direct association with graft survival
Comparing high percentage of DGF with other study involving younger donor may reflect the association between older donor age and DGF
Donor eGFR were significantly associated with total duration of graft survival even if we put other variables in consideration
High incidence of graft rejection may be associated with high rate of DGF
So, it is concluded that:
kidney from deceased donors is a good source of donation
Better eGFR selection associated with better survival
Better HLA-DR matched kidney also associated with better outcome
Better immunologic manipulation to ensure less rejection episodes and hence longer graft survival and outcome
amiri elaf
2 years ago
IV. Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes Please provide a summary of this article
The aim:
*To estimate risk factors that could negatively affect the outcomes from elderly deceased donor transplants.
Introduction:
*The large gap between patients on the deceased-donor kidney wait list and the number of deceased donors has made expansion of the criteria for organ donation inevitable.
*Many studies showed that donor age has an adverse effect on graft survival, but kidneys from very young donors are also associated with poor outcome, may be due to technical complications and graft thrombosis.
*The patient survival at the end of the first and third year PKT were comparable between expanded criteria donors and standard criteria donors; however, graft survival and function were significantly worse with increased incidence of (DGF) and acute rejection episodes.
*There is no statistical significant correlation between donor age and 5-year graft function, so donors who were previously considered as not ideal are now considered to be suitable.
The methods:
* Single center retrospective study (112 patients), they studied the effect of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient co morbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
The results:
* Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years.
* Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%.
*Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years. Cold ischemia time, recipient co morbidity, and total HLA antigen
mismatch did not significantly affect graft outcome.
*Acute rejection episode was an independent predictor of graft outcome.
* Donor age was a predictor of total graft survival duration ( P = .002).
* Donor estimated glomerular filtration rates ≥ 60 mL/min produced
better outcomes than those < 60 mL/min (P = .007).
*Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes( P < .001) and donor estimated glomerular filtration rate (hazard ratio 0.449; 95% P = .035) remained significant predictors of cumulative graft survival.
Conclusions
*Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors mentioned above are avoided.
* Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival; better HLA-DR matched kidneys will produce better outcomes. *Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
Hamdy Hegazy
2 years ago
Please provide a summary of this article This is a retrospective study of at Sheffield kidney center between March 1969- March 2009. Aim: assess the outcomes of recipients received renal transplants from elderly donors aged 60 years and above.
Study population: Renal Transplant Recipients received DD from donors aged 60 years or above at Sheffield kidney center between March 1969- March 2009.
Results: Patient survival: 91.9% at 1 year, 82.1% at 3 years, and 78.2 % at 5 years. Graft Survival: 80.4% at 1 year, 67.7% at 3 years, and 63.6% at 5 years. Donor’s age and e-GFR were negative predictors of graft survival. Total number of HLA mismatches, cold ischaemia time, and recipient comorbidity had no significant association with short-term and long-term graft survival. Conclusion: Graft outcomes are affected more by donor’s e-GFR than donor’s age. The less HLA mismatches, and lower incidence of acute rejection, the better the graft outcomes.
Mohammed Sobair
2 years ago
Introduction:
Most studies have indicated that donor age has an adverse effect on graft survival. However, kidneys from very young donors are also associated with poor outcome, likely related to technical complications and graft thrombosis.
The study explore transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above) at a single center. Materials and Methods:
A retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 200
Graft and patient survival outcomes of kidney transplants from elderly donors by retrieving the following:
Donor factors: donor age, sex, serum creatinine level, estimated glomerular filtration rate (eGFR), and cold ischemia time.
The following recipient factors were also obtained: patient status (dead or alive), age, sex, comorbidities (cardiovascular disease, type 2 diabetes mellitus, cerebrovascular disease, and hypertension), type of immunosuppressants used, and number of acute rejection episodes, DGF, and eGFR at 3, 12, and 60 months after transplant.
Donor ages were categorized as follows: 60 to 64 years old, 65 to 69 years old, and ≥ 70 years old.
The following donor recipient factors were obtained:
HLA antigen mismatches, HLA-DR only mismatches.
Total follow-up, total duration of graft survival, and graft and recipient survival at 1, 3, and 5 years after transplant.
. The acute rejection episodes were as reported in hospital records. All of the episodes were confirmed by kidney allograft biopsy.
Delayed graft function was defined as the need for dialysis within the first week of transplant.
The eGFR was obtained MDRD. Predictive analysis of graft survival with univariate analysis:
Donor age and donor serum creatinine level were significantly correlated with total duration of graft survival. Discussion:
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration. Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or the long term.
The incidence of delayed graft function in our study was quite high (40.2%). This may indicate susceptibility of kidneys from elderly donors to delayed graft function.
It is noteworthy that the donor eGFR in this study was significantly associated with total duration of graft survival and was an independent predictor of cumulative survival even when other donor, recipient, and donor-recipient factors were taken into consideration.
High incidence of acute rejection episodes in this study (33.9%). Conclusions:
Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors mentioned above are avoided.
Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival; better HLA-DR matched kidneys will produce better outcomes.
Amit Sharma
2 years ago
Please provide a summary of this article
Due to the demand-supply gap for renal transplant, need of using elderly donors (expanded criteria donors) for kidney transplant has arisen. The graft and patient outcomes in such cases need evaluation.
This was a retrospective study undertaken to evaluate the risk factors affecting outcomes of elderly (>60 year) deceased donor renal transplants at a single centre (Sheffield Kidney Institute) between 1969 and 2009. The patient and graft survival were determined by assessing donor age, gender, serum creatinine, eGFR and cold ischemia time. Recipient factors like age, total HLA mismatch, HLA-DR mismatch, and comorbidities were also assessed. Acute rejection episodes and delayed graft function (DGF) were recorded.
A total of 112 donors (59 females) were included. They were found to have patient survival of 91.9%, 82.1%, and 78.2% at 1-, 3-, and 5-years post-transplant. The corresponding figures for graft survival were 80.4%, 67.7%, and 63.3%. Donor age and eGFR negatively predicted graft survival. Donors with eGFR <60 ml/min had poorer graft survival than those with higher eGFR. Donor age was not significant predictor of total duration of graft survival while donor eGFR and acute rejection episodes were significant predictors of cumulative graft survival. It signifies that the quality of the donor kidney (eGFR) is more important than the donor age.
Cold ischemia time, total HLA mismatch and recipient co-morbidities did not have association with graft survival. Number of HLA-DR mismatch was associated with poorer graft survival. Although DGF was 40.2% in the study, it had no effect on long-term outcomes. Age difference predicted graft survival.
To conclude, donor selection based on eGFR is more important factor for graft outcomes than the donor age. Better HLA-DR matched kidneys and avoiding acute rejection episodes by optimal immunosuppression help in achieving better graft outcomes.
rindhabibgmail-com
2 years ago
The objective of this study is evaluate the risk factors associated with elderly donors and poor outcomes.
Its a retrospective single center study, from 1969 to 2009, it included deseased donors age 60 years or more.
It included elderly donors to see there survival which was 91.9%, 82.1%, and 78.2% out of 112 transplants at one , three and five years respectively. graft survival 80,4%, 67.7% and 63.6% at 1, 3 , and 5 years.
It was seen kidney from donors 70 years and older has the best cumulative survival, however, in multivariant analysis there was no difference.
This study showed that the age is not related to patient or graft survival it relates to eGFR.
So the conclusion is that elderly donors could be much valuable source of organ.
balaji kirushnan
2 years ago
Shortage of organs from deceased donors in a cadaver program highlights the importance of organ retrieval from elder donors (>60 years) and even Donor after cardiac death (DCD)…Previous studies have shown no difference in patient survival after 1 and 5 years after transplants in extended criteria donor and Standard criteria donor….But the studies do show an overall poor graft survival in extended criteria donors with increase in the incidence of DGF and Acute rejections….Before this study they were many reports that donor age was not statistically significant and not associated with 5 year graft outcome….
This was a retrospective study done in a single center at Sheffield hospital between 1969-2009…The inclusion population were the donors > 60 years ago..The exclusion criteria was donors <60 years and those with live related transplant ….
112 donors were included in the study.. Majority (59) of them were females and the mean age of donors were 64 + 4 years… Among the 112 recipients, 38 were female recipients… DGF was reported in 40.2% of the recipients…Acute rejection episodes were 38%….Patient survival was 91%,82% and 78% at 1,3 and 5 years respectively…Graft survival was 80%, 67% and 63% at 1,3 and 5 years respectively…The univariate analysis model gives different results when assessed….Donor age and donor serum creatinine correlated with graft survival…Donor eGFR and age negatively predicted graft survival when analyzed as univariate analysis….Kaplan Meir Model of survival analysis showed that use of donor eGFR>60ml/min produced better overall graft survival as compared to those eGFR<60ml/min….Multivariate cox regression analysis show that donor eGFR and acute rejection episodes and not donor age was predictive of the overall cumulative graft survival….
this retrospective analysis shows that quality of donor kidneys based on eGFR is a better predictive of overall graft survival than donor age….proper selection of donors based on eGFR and less HLA DR mismatches and immunological management to avoid rejection episodes should be attempted
Esraa Mohammed
2 years ago
there are reports concluding that there is no statistical significant correlation between donor age and 5-year graft function. Therefore, donors who were previously considered as not ideal are now considered to be suitable
-Donor characteristics In the 112 transplants performed during the study period, there were 112 donors. Fifty-nine of the donors were females (52.7%). The mean donor age was 64.71 ± 4.00 years.
-Recipient characteristics Of 112 recipients, thirty-eight were females (33.9%).
-Patient survival At 1 year, patient survival was 91.9%. At 3 years, patient survival was 82.1 %, whereas 5-year patient survival was 78.2%.
-Graft survival At 1 year, graft survival was 80.4%. At 3 years, graft survival was 67.7%, whereas 5-year graft survival was 63.6%.
Multivariate Analyses of Total Duration of Graft Survival (Dependent Variable) and Donor, Recipient, and Recipient-Donor Variables (Independent Variables)
Acute rejection episodes
Delayed graft function
Age difference
HLA-DR only mismatch
HLA antigen mismatch
Comorbidity in recipients
Cold ischemia time
eGFR in categories
Donor age in categories
Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors mentioned above are avoided. Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival; better HLA-DR matched kidneys will produce better outcomes. Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
Zahid Nabi
2 years ago
Organ shortage is a real issue which needs to be addressed and each transplant program is trying their best to overcome this issue.According to OPTN data around 92000 patients are on waiting list and each year almost 10000 are either dying or getting too sick to get a transplant. Accepting elderly donor can be a way to increase donor pool. The authors of this paper have tried to see the impact of utilizing elderly deceased donors on graft outcome.
This was a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009.
In this single center retrospective study (112 patients), they studied the impact of
acute rejection episodes,
delayed graft function,
donor-recipient age differences,
HLA-DR mismatches,
HLA antigen mismatches,
recipient comorbidities,
cold ischemia time,
donor and recipient age,
and donor serum creatinine level on short- and long-term graft survival.
Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years.
Delayed graft function was 40.2%,
whereas acute rejection episode rate was 38%. Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Acute rejection episode was an independent pre- dictor of graft outcome
Donor age was a predictor of total graft survival duration.
Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min.
Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes and donor estimated glomerular filtration rate remained significant predictors of cumulative graft survival.
Conclusion. Age should not be a limiting factor while assessing deceased kidney donation and graft outcome is comparable if donors are selected appropriately
Muntasir Mohammed
2 years ago
Objectives:
To evaluate risk factors associated with elderly donor and poor outcome.
Materials and Methods:
This is retrospective single center study. It included deceased donors age 60years or more, from 1969 to 2009 atSheffield Kidney Institute.
Results:
112 transplants from elderly donors were included in the study period.
Patient survival was 91.9%, 82.1% and 78.2% at one, three and five years respectively.
Graft survival was found to be 80.4%, 67.7% and 63.6% at one, 3years and 5years respectively.
Donor age and serum creatinine were significantly associated with duration of graft survival.
Kidneys from donors 70years or old has shown the best cumulative survival, however in multivariate analysis there was no difference.
Discussion
Shortage of organs led to use of expanded criteria donor. Kidneys from elderly donors showed good survival almost like younger donors. This study showed that age is not related to patient or graft survival also.
Conclusions
This study showed that elderly donors could be valuable source for deceased organs provided that it is selected properly specially preserved GFR.
Hussam Juda
2 years ago
Introduction
· To expand the criteria for organ donation, elderly donors were accepted.
· patient survival at the end of the first and third year after transplant were comparable between expanded criteria donors and standard criteria donor
Materials and Methods
· Inclusion criteria: deceased-donor transplants from donors ≥ 60 years old and kidney transplant that occurred between March 1969 and February 2009
· Exclusion criteria:
1- deceased-donor transplants from donors < 60 years old
2- living-donor transplants of any donor age
3- deceased- or living-donor transplants before March 1969 or after February 2009
· All of the episodes of acute rejection were confirmed by kidney allograft biopsy, reported in hospital records
· Delayed graft function was defined as the need for dialysis within the first week of transplant.
· MDRDe used to estimate GFR
Results
· 52.7% of the 112 donors were females, and the mean donor age was 64.71 ± 4.00 years
· 33.9% of 112 recipients, were females
· Patient survival at 1, 3, and 5 years, was 91.9%, 82.1 %, and 78.2% respectively.
· Graft survival at 1,3, and 5 years, was 80.4%, 67.7%, and63.6%, respectively.
Discussion
· Graft function has been found to be independent of age of the donor
· Cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches had no significant association with graft survival, in either the short or long term
· While Opelz and associates, found that HLA antigen mismatches significantly influenced the outcome of kidney transplants
· The incidence of delayed graft function in this study was high (40.2%), could be due to susceptibility of kidneys from elderly donors to delayed graft function
· But, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old
· The quality of donor kidneys (ie, donor eGFR) might be more important than donor age
· The high incidence of acute rejection episodes in this study (33.9%), could be related to the delayed graft function, or due to reduction of immunosuppressive drugs
· cold ischemia time was not significantly associated with overall graft survival in this study
Conclusions
· Elderly deceased donation is accepted with no risk factors
· The outcome and graft survival depends on eGFR before donation
· Better HLA-DR matched kidneys have better outcomes
· Avoidance of acute rejection with the proper immunosuppressive drugs, to reduce nephron mass
Naglaa Abdalla
2 years ago
This is a single center retrospective study on 112 patients who received kidneys from elderly deceased donors age 60 years or above at Sheffield kidney institute between March 1969 and February 2009 evaluating the risk factors of poor outcome. The donor factors : donor age, sex, serum creatinine level, estimated glomerular filtration rate (eGFR), and cold ischemia time. The recipient factors:
patient status (dead or alive), age, sex, comorbidities
(cardiovascular disease, type 2 diabetes mellitus,
cerebrovascular disease, and hypertension), type of
immunosuppressant used, number of acute
rejection episodes, DGF, and eGFR at 3, 12, and 60
months after transplant.
HLA antigen mismatches, HLA-DR only mismatches, total
follow-up, total duration of graft survival, and graft
and recipient survival at 1, 3, and 5 years after transplant.
Reports of the acute rejection biopsies results were taken. The results: Patient survival : 1 year, patient survival was 91.9%, 3 years patient survival was 82.1 %, whereas 5-year patient
survival was 78.2%.
Graft survival : 1 year, graft survival was 80.4%, 3 years graftsurvival was 67.7%, whereas 5-year graft survival was63.6%.
Thus graft function is expected to be good when other risk factors are not present and proper donor, immunosuppression usage and better HLA-DR matched kidneys.
Abdul Rahim Khan
2 years ago
Please provide a summary of this article
Many studies have indicated that kidney donation from old donor may be associated with poor outcomes and other studies have found poor outcomes when donor is young due to technical complications and graft thrombosis. Studies have also shown that outcome at 1 and 3 year was comparable between standard and expanded criteria donors.
Objective of study
To evaluate the risk factors associated with poor outcomes in elderly kidney donors.
Methodology
Retrospective study evaluated the short and long term graft survival by looking at effect of -acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level.
Results-
Acute rejection rate was 38%
DGF in 40%
Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Donor age not an important predictor of outcome
Donation with eGFR > 60 ml had better outcomes as compared to those with eGFR <60 ml
Donor age and eGFR were directly related to cumulative graftoutcomes.
Conclusion
Emphasis should not be on donor age only but factors leading to poor outcomes should be avoided . Both good donor kidney function and proper immune suppression are tools to achieve better outcomes.
Marius Badal
2 years ago
summary: kidney disease is in arise and such there must be ways to receive donors to decrease the demand. This article is about kidneys from deceased elderly donors, and factors associated with adverse outcomes. The study explored the outcomes of patients that received kidneys from older donors. The study is a retrospective one of all the recipients who received deceased donors with a donor age of 60 years and above. The study was conducted at the Sheffield Kidney institute from a period of 1969-2009. The criteria for donor selection are that the deceased donor transplant age must be greater than 60 years and above and from a period of March 1969 to February 2009. The criteria for not including deceased donor transplantation is donors less than 60 years, living donor transplantation of any age, and anyone from before March 1969 and after February 2009. From the above, the following results were obtained that there were 112 recipients and 112 donors. – It was noted that donors with a GFR greater than 60 ml/min did better than those less than that GFR. -Having acute rejection episodes and donor GFR was important as it relates to cumulative graft survival. -Age was not a factor as it relates to total graft survival and donor age and DGF were not significant predictors of the graft outcome.
In the study, there was no significant association as regards donor age when other donor-recipient factors are considered. There were high DGRs that can be related to elderly donors. It was found that acute rejection was high and it may be related to the high incidence of DGF or possible immunosuppression reduction. So in conclusion, one can say that the better the GFR the better will be the recipient graft survival. Receiving a kidney from a deceased donor is a great source of the donation. If the kidneys are properly matched that is their HLA-DR, the better will be the graft survival. Having better drugs to prevent rejection that is a better protocol is likely to directly influence on graft survival and its outcome.
Rehab Fahmy
2 years ago
Currently as there is small numbers of donors available for kidney transplantation especially deceased donors ,So there is urgent need to expand the criteria to accept donors ,
This paper aims at not having a cutoff limit in donor age as other factors can affect graft and patient survival more than Age
Methedology:
112 patients deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009
they studied other factors that can affect graft and patient survival like:
1-No. of acute rejection episodes
2- Incidence of delayed graft function,
3- Donor-recipient age differences
4-HLA-DR mismatches ,HLA antigen mismatches
5- Recepient comorbidities
6- Cold ischemia
7- Donor and recepient age
8- Donor serum creatinine level
They addressed all these factors impact on short- and long-term graft survival.
I
Results:
1-Delayed graft function was 40.2% but it did not have significant effect on graft outcome
2- Acute rejection episode rate was 38% which was independent predictor of graft outcome.
3-Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
4- Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
5-Donor age was a predictor of total graft survival duration but not significant predictor of graft outcome .
6-Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min.
They found no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration. cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
Discussion:
Comparison to other studies done in this issue:
1-Moreira and associates reported delayed graft function of 19% among 997 deceased-donor kidney transplants.23 The incidence of delayed graft function in our study was quite high (40.2%).and has significant effect on long term survival of the graft ,in this study high incidence of DGF but there was no effect on long term graft outcome .
2-Other studies reviewed effect of donor age on living donors but still no more studies on Deceased donor age and this makes the basis of Eurotransplant Senior Program that was started in 1999.
So they concluded that that other factors should be considered in correlation of donor age to graft survival like Epsiodes of acute rejection and delayed graft function which may change the current thinking and expand the pool of accepted deceased donor for kidney transplant .
CARLOS TADEU LEONIDIO
2 years ago
Please provide a summary of this article
There is a need to expand the criteria for organ donation due to the long waiting time on the list. One of the most important criteria has to do with age. The article attempts to study the risk factors that could adversely affect outcomes from elderly deceased-donor transplants.
A retrospective study was carried out, where all recipients of deceased donors over 60 years of age in the period between 1969 and 2009 and the donor-recipient factors were obtained: HLA antigen mismatches, HLA-DR only mismatches, total follow-up, total duration of graft survival, and graft and recipient survival at 1, 3, and 5 years after transplant.
Among the results I highlight::
– At 1 year, patient survival was 91.9%. At 3 years, patient survival was 82.1 %, whereas 5-year patient survival was 78.2%.
– At 1 year, graft survival was 80.4%. At 3 years, graft survival was 67.7%, whereas 5-year graft survival was 63.6%.
– univariate analysis concluded that donor age and donor serum creatinine level were significantly correlated with total duration of graft survival
– multiple regression model showed that: age differences, donor eGFR, and donor age are independent predictors of total duration of graft survival, where donor eGFR and age negatively predicted graft survival.
– Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival;
So, the factor for a more appropriate choice related to an eldery donor is a, associated with the lowest possible age. After that, only HLA-DR matched kidneys will produce better outcomes, as they will lead to a choice of immunosuppressants with less risk of adverse effects and failure with graft rejection.
Wael Jebur
2 years ago
A retrospective study conducted to emphasize on the adverse features that compromise the long term survival of the elderly deceased donor renal allograft.
112 recipients involved. Donors age ranged from 64-+4 years in Sheffield medical institute from 1969 through 2009{ it principally investigated the outcome of transplanting a kidney from a deceased donor of above 60 year of age}.
Parameters considered in this study include:
Age of donors, sex, creatinine and glomerular filtration rate ,cold ischemia time,
Recipients criteria includes: patient survival,age and sex.
Comorbidities: Cerebrovascular disease, cardiovascular disease, type 2 diabetes mellitus and hypertension. immunosuppressants used, number of acute rejection episodes, delayed graft function and eGFR at 6, 12 and 60 months.
Donors ages categorized into 3 groups 60-64, 65-69 and above 70.
Donors, recipients features were highlighted accordingly:
1-HLA antigens mismatchs
2-HLA-DR antigen only mismatch
3-total duration of graft survival.
4-recipient and allograft survival at 1. 3 and 5 years.
Delayed graft function was elucidated as : The need for dialysis in the first week post transplantation.
Acute rejection was featured as per the hospital records and based on allograft biops7 findings.
eGFR was explicated by MDRD .
Non graft survival or graft loss : was interpreted as rise in serum creatinine that required renal replacement for any underlying etiology in the first week post transplant.
Results:
Graft survival was 80% , 67% and 63% at 1, 3 and 5 years .
The graft survival was significantly correlated to donors age and serum creatinine .
eGFR of more than 60 ml/min was correlated with better allograft survival then those with e GFR of less than 60 ml/min.
Acute rejection episodes were linked to worse graft survival , which is indicating the diminished nephron mass endowed to elderly deceased kidneys which would be further lost by the repeated acute rejection episodes . Donor age was not significantly associated with allograft survival. Acute rejection episodes were reported to be higher incidents in those patients , This basically pertinent to the practice of reducing the immunosuppression for potential enhancement of DGF recovery ..Therefore, optimization of anti rejection protocol is one of the main recommendations put forth by this study.
Mahmud Islam
2 years ago
With the burden of ESRD, the optimal RRT is renal transplantation. With an exponential increase in patients on the waiting list, the need for deceased and ECD is prominent. It is known that graft function is affected adversely with the increase in donor age. In this study, 112 patients were evaluated as we can see in figures 2&3 (Kaplan Meier survival analysis), there is a prominent difference in outcome (better in age under 60). Multivariate analysis showed a nonsignificant effect of the donor’s age; in contrast, acute rejection episodes and donor age were associated with graft survival. Donors with eGFR less than 60 ml/min had worse outcomes than grafts retrieved from donors with eGFR>60 ml/min.
Abdullah hindawy
2 years ago
introduction
this study explored transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above) at a single center.
a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009 inclusion criteria :
were deceased-donor transplants from donors ≥ 60 years old and kidney transplant that occurred between March 1969 and February 2009. excluded criteria :
deceased-donor transplants from donors < 60 years old, living-donor transplants of any donor age, and deceased- or living-donor transplants before March 1969 or after February 2009
results :
the use of kidneys from donors with eGFR of 60 mL/min produced better cumulative graft survival than those with eGFR less than 60 mL/min
donor age was not a significant predictor of total duration of graft survival
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration. Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
the study shows high incedince of acute graft rejection .
limitation :
immunosuppression protocols was changed in our unit from cyclosporine based to tacrolimus based in 2002. This had no effect on the message conveyed in this study as it addresses the various risk factors that could adversely lower graft survival regardless of the immunosuppressive agents used. Also, cold ischemia time was not significantly associated with overall graft survival in our study
Huda Saadeddin
2 years ago
In general rather than donor age Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.
Results:
Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years.
Delayed graft function was 40.2%
acute rejection episode rate was 38%
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min
—————————————-
studies have shown that patient survival at the end of the first and third year after transplant were comparable between expanded criteria donors and standard criteria donors; however, graft survival and function were significantly worse with increased incidence of delayed graft function DGF) and acute rejection episodes.
In addition, there are reports concluding that there is no statistical significant correlation between donor age and 5-year graft function. Therefore, donors who were previously considered as not ideal are now considered to be suitable.
Discussion
The acute shortage of donor organs for kidney transplant has necessitated the expansion of criteria for deceased donors in many institutions. The extended criteria donor has been well defined.
>>> Despite many criticisms against the use of kidneys from elderly donors, graft function has been found to be independent of age of the donor.
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
Again our study, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old.
The quality of donor kidneys (ie, donor eGFR) might be more important than donor age.
Conclusions
Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survivals
better HLA-DR matched kidneys will produce better outcomes
Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
Reem Younis
2 years ago
Please provide a summary of this article
Studies have shown that patient survival at the end of the first and third year after -transplant were comparable between expanded criteria donors and standard criteria donors .
-Graft survival and function were significantly worse with increased incidence of delayed graft function (DGF) and acute rejection episodes.
-There are reports concluding that there is no statistical significant
correlation between donor age and 5-year graft function. Therefore, donors who were previously considered as not ideal are now considered to be suitable.
– It was a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute
between March 1969 and February 2009.
-The acute shortage of donor organs for kidney transplant has necessitated the expansion of criteria for deceased donors in many institutions.
-There is no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
-Cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
– The incidence of delayed graft function in the study was quite high (40.2%). This may indicate susceptibility of kidneys from elderly donors to delayed graft function.
-In the study, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old.
-There was no reference to definitive measure of the association between the eGFR and graft survival.
-Age difference might have a role in kidneys from deceased donors in the presence of other risk factors .
-It may be due to reduction of immunosuppressive therapy in an attempt to help
the elderly kidneys recover from delayed graft function.
-Acute rejection episodes demonstrated adverse effects on graft survival. This result may be due to reduced nephron mass of these donor kidneys.
-Proper donor selection based on eGFR and better HLA-DR matched kidneys will
produce better outcomes.
Nandita Sugumar
2 years ago
Summary
This study reveals the factors associated with adverse outcomes when using kidneys from deceased elderly kidney donors.
The given study estimates that many factors that are usually considered to have a massive effect on graft outcome are not the major ones in case of elderly donors. These include cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches.
Delayed graft function from reduced immunosuppression can have an effect on graft function. Increased number of acute rejection episodes can result from reduced immunosuppression, and this can further affect graft outcome. This result is due to the reduced nephron mass of the donor kidneys .
The study concludes with the following recommendations :
do not reject or accept based on donor age alone
consider the above mentioned risk factors carefully and proceed with transplantation
improved outcomes are a result of good donor kidney function and proper immunosuppressive therapy
Ghalia sawaf
2 years ago
This retrospective single center study explored transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above).
Population of study;
• All recipients who had DD kidney transplants, with donor age 60 years and above,
• at Sheffield Kidney Institute
• between March 1969 and February 2009.
Excluding criteria
1. deceased-donor transplants from donors < 60 years old,
2. living-donor transplants of any donor age,
3. deceased- or living-donor transplants before March 1 969 or after February 2009.
following recipient factors were obtained:
• patient status (dead or alive)
• age
• sex
• comorbidities
• (CVD, type 2 DM, and hypertension)
• type of immunosuppressants used number of acute rejection episodes
• DGF
• eGFR at 3, 12, and 60 months after transplant.
Patient survival
• At I year, was 91.9%.
• At 3 years, patient survival was 82.1 %,
• whereas 5-year patient survival was 78.2%.
Graft survival
• At I year, was 80.4%.
• At 3 years, was 67.7%,
• whereas 5-year graft survival was 63.6%.
Predictive analysis of graft survival with univariate analysis Donor age and donor serum creatinine level were significantly correlated with total duration of graft survival.
They compared duration of graft survival as the dependent variable. With The independent variables included total HLA antigen mismatch, HLA-DR mismatch, recipient comorbidities, cold ischemia time, age differences, DGF, acute rejection episodes, donor eGFR, and donor age.
The result that Donor eGFR and age negatively predicted graft survival.
However, This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
Similarly cold ischemia time, recipient comorbidity and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
Conclusion
1. Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors are avoided.
2. Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival,
3. better HLA-DR matched kidneys will produce better outcomes.
4. Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
– This study evaluates the risk factors that could adversely affect outcomes from elderly deceased donor transplants.
– In this single center retrospective study (112 patients) , the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival were studied ..
– It demonstrated that demonstrated there is no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
– Also in this study, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old.
– donor eGFR in this study was significantly associated with total duration of graft survival and was an independent predictor of cumulative survival even when other donor, recipient, and donor-recipient factors were taken into consideration.
Conclusion :
– Kidneys from deceased elderly donors could be a
valuable source, so, Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival, also, better HLA-DR matched kidneys will produce better outcomes.
– Proper immunologic assessment to avoid the adverse effects of acute
Donor age has an adverse outcome in most studies. Patient survival was comparable between ECD and SCD but graft survival and function were significantly affected with DGF and acute rejection
Studies comparing donor age with graft function were inconclusive
Aim of the study: retrospective descriptive study to evaluate the outcomes (graft and patient survival) of patients who received kidneys from elderly donors (aged 60 years and above)
Materials and Methods
All recipients who were received kidneys from deceased elderly donors (aged 60 years and above) in one center (Sheffield Kidney Institute between1969 and 2009)
Donor factors:
1. Donor age: categorized 60-64, 65-69, and ≥ 70 years old (The mean donor age was 64.71 ± 4.00 years)
2. Sex (52.7% were female)
3. Serum creatinine level
4. eGFR
5. Cold ischemia time
Recipient factor:
1. Patient status (dead or alive)
2. Age (mean age 50.39 ± 13.72)
3. Sex (33.9% were female)
4. Comorbidities (CV disease, type 2 DM, CVA, and HTN)
5. Type of immuno suppressants used
6. Number of acute rejection episodes
7. DGF
8. eGFR at 3, 12, and 60 months after transplant
Donor- recipient factors:
1. HLA antigen mismatches
2. HLA-DR only mismatches
3. Total follow-up
4. Total duration of graft survival
5. Graft and recipient survival at 1, 3, and 5 years after transplant
Acute rejection: all were confirmed with allograft biopsy
DGF: need for dialysis within the first week of transplant
eGFR: (MDRD equation)
Graft loss or nongraft survival: rise in serum creatinine requiring RRT within the first week of transplant
Results
There were 112 recipients and 112 donors
Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years
Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome
Donor age was not a significant predictor of total duration of graft survival
Donor age and DGF were not significant predictors of graft outcome
Kidneys from donors with eGFR of 60 mL/min produced better cumulative graft survival than those with eGFR less than 60 mL/min
Acute rejection episodes and donor eGFR were significant predictors of cumulative graft survival
Discussion
In this study, no significant association regarding donor age when other donor-recipient factors are considered
In this study there was high DGF (40.2%). May be due to DGF from the elderly donors
Also the incidence of acute rejection episodes was high (33.9%). This could be related to the high incidence of DGF or immunosuppression reduction
Conclusion
Kidneys from deceased elderly donors are useful ifrisk factors are avoided
Donor selection based on eGFR and better HLA-DR matched kidneys will produce better outcomes.
This is a retrospective study which had involved all deceased donors aged 60 and above in Sheffield Kidney Institute in the period 1969 – 2009. It focused on the adverse outcome associated with kidney grafts from deceased elderly donors. At 1 year, patient survival was 91.9% which dropped after 5-year to 78.2%. Graft survival at 1 year was 80.4% and by 5 years it was 63.6%. graft survival was significantly associated with donor age , donor serum creatinine and the age difference between donor and recipient. donors age 70 years and older had the highest cumulative survival but multivariate analyses of cumulative graft survival as a function of donor age after correcting for acute rejection episodes, delayed graft function, and donor estimated glomerular filtration rate, donor age and dgf were not significantly association with cumulative graft survival using this model .
This study demonstrates that , in elderly donors, there is no significant association between graft survival and cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches which contradict many studied conducted in the other different age groups .
Honda please revise the article and organize the answers
Heba Wagdy
2 years ago
Shortage of donor pool resulted in expanding the criteria for accepting donors, factors with adverse effects on graft survival were studied and showed that patient survival was similar in both expanded criteria donors and standard criteria donors.
Previous studies showed that graft function was independent of age of donor while DGF and acute rejection episodes were associated with worse graft outcome.
This study aimed to determine the outcome of kidney transplantation from elderly donors >60 years.
It was a retrospective study, included 112 deceased donor transplants with donors >60 years, donors were categorized according to age into 60-64 years, 65-69 years and >70 years.
The study showed that donor age was not significantly associated with graft outcome, also cold ischemia, recipient comorbidities and HLA mismatch were not associated with graft survival.
The incidence of delayed graft function was 40.2% indicating susceptibility of kidneys from elderly donors to delayed graft function but it was not a predictor of long-term outcome in elderly donors.
eGFR was significantly associated with duration of graft survival and was an independent predictor of survival indicating that quality of donor kidney was more important than donor age.
Age difference between donor and recipient predicted graft survival and may have a role in kidneys from deceased donor.
The incidence of acute rejection episodes was also high in this study and were associated with adverse effects on graft survival.
The patient survival in this study was similar to other single center studies
Cold ischemia time was not significantly associated with graft survival.
Proper donor selection based on eGFR may ensure better post transplant function and better graft survival and better HLA-DR matched kidneys will result in better outcome.
Proper selection of kidneys from deceased donors with avoiding risk factors can increase donor pool with similar outcome as living donors.
As we need for donor to reduce the burden of ESRD and global implications ,expanded criteria for donation which is include older age for donation.
Aretrospective study was done in Sheffield from 1969 to 2009 found that
Kidneys from deceased elderly donors could be a valuable source. Proper donor selection based on eGFR may ensure better posttransplant function and better graft survival. Better HLA-DR-matched kidneys will produce better outcomes. Proper immunologic manipulation to avoid acute rejection episodes with their effects on the reduction of the nephron mass is essential.
this found to have no association between donor age and graft survival ,so we can accept older age for donation but still there is eGFR is directly related to the total graft survival .
Good conclusion but some details are needed to reach them
Filipe prohaska Batista
2 years ago
This is a single-center retrospective cohort study collecting data related to kidney transplantation from an elderly deceased donor (over 60 years of age) from March 1969 to February 2009. This study separated into three age groups (60 to 64; 65 to 69 and over 70 years) and evaluated a range of clinical and immunological outcomes.
The study evaluated 112 donors in this period, with a mean age of 64.71 years, where most donors were women (52.7%) and most recipients were men (66.1%). Patient survival was 91.9% (1 year), 82.1% (3 years) and 78.2% (5 years). The graft survived 80.4%, 67.7%, and 63.6% respectively in the same period. Donors with better eGFR (>60mL/min) had a better outcome. Age difference and younger donors also had more favorable outcomes.
In this study, late graft response was considered high (around 40%), but an important finding is that the quality of the donor (eGFR > 60mL/min) may be higher and more important than the age of the donor itself. . Other findings such as HLA DR match and good immunological correlation decrease the risk of rejection and increase graft survival.
This is retrospective study of all recipients who have deceased donor kidney transplantation with donor age 60 years or above.
Outcome of kidney transplant from elderly donors done by following donor factors:
Donor age
sex, s.creatinine level, e GFR and cold ischaemia time.
The following recipient factors, age, sex, comorbidities and hypertension.
Delayed graft function was 40.2%, acute rejectin rate was 38%. Graft and patient survival rates were 80.4% and 67.7% and 91.9% and 82.1% and 78.2% and 78.2% at 1,3 and 5 years.
Donor age was was a predictor of total graft survival duration.
Cold ischaemia time, recipient co morbidity and total HLA antigen mismatch did not significantly affect graft function.
Then what were the concluded factors most effective in this article
KAMAL ELGORASHI
2 years ago
Summary of the article:
As the number of ESKD patients are globally increased, and the need of organ donation are also increased, so increase organ donation by increasing donor pool are highly required, as kidney transplant considered the best modality treatment of kidney failure. Material and methods:
retrospective study done at Sheffield Kidney Institute between March 1969 and 2009, including all kidney transplant from deceased donor > 60 years old.
Graft and recipients’ survival are determined by the following factors: donor age, sex, sCr level, eGFR, and CIT.
Recipients’ factors: patient status, age, sex, comorbidities, Type of immunosuppressant used, number of acute rejection episodes, DGF, and eGFR at 3, 12, and 60 months after transplantation.
donor age categorizes as follow;(60-64), (65-69), (and >70) years old.
Donor/Recipients factors; HLA MM, HLA-DR only MM, Total follow-up, Total duration of graft failure, Graft and Recipient survival at 1, 3, 5, years’ post-transplant.
All rejections are registered and biopsy-based diagnosis.
DGF defined as need for dialysis within the first week of transplant
Results: Donor charaecteristics:
112 transplant done during the study period.
59% were females, (52,7%).
Mean donor age was 64.71+/-4 Ys.
SCr 95.64+/-33.46 mic
eGFR 66.03+/-21.85 (<60 42== >60 56)
Recipients charecteristics:
38 were females (33.9%)
Mean age 50.39+/-13.72
DGF 40.2%
Acute rejection 38%
Comorbidities 36
D/R factors:
CIT /min 1026.40+/- 405.16
Total HLA antigen MM 62
HLA-DR MM 11
Age difference 15.79+/-12.09
Patient survival; at 1 yrs was 91.9%, At 3 yrs82.15, At 5 yrs 78.2%.
Graft survival At 1 yrs was 80.4%, At 3 yrs was 67.7%, At 5 yrs was 63.65. Total duration of graft survival was significantly associated with donor age and serum Cr.
Use donor kidney with eGFR >60 had better survival than those with eGFR < 60. kidneys from donor’s age >70 had better cumulative survival rate . Discussion: increasing need for kidney for donation necessitated ECD in many institutions
Graft survival was found to be independent from donor age and so expanding criteria for donation as in the past donation from older age was unfavorable. No significant association between donor age and other D/R variables In contrast Opelz conclude that HLA MM had a direct association with graft survival Comparing high percentage of DGF with other study involving younger donor may reflect the association between older donor age and DGF Donor eGFR were significantly associated with total duration of garft survival even if we put other variables in consideration High incidence of graft rejection may be associated with high rate of DGF Conclusion :
kidney from deceased donors is a good source of donation
Better eGFR selection associated with better survival
Better HLA-DR matched kidny also asociated with better outcome
Better immunolgic manipulation to ensure less rejection episodes and hence longer graft survival and outcome
Aim of the study:
To evaluate risk factors that could adversely affect outcomes from elderly deceased donor transplants.
Methods:
A retrospective study.
Recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009.
The inclusion criteria: deceased-donor transplants from donors ≥ 60 years old and kidney transplant that occurred between March 1969 and February 2009.
The exclusion criteria: deceased-donor transplants from donors < 60 years old, living-donor transplants of any donor age, and deceased- or living-donor transplants before March 1969 or after February 2009.
The impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival were studied.
Results:
The mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years. Delayed graft function rate was 40.2%.
Acute rejection episode rate was 38%.
Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Acute rejection episode was an independent predictor of graft outcome.
Donor age was a predictor of total graft survival duration.
Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min.
Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome, whereas acute rejection episodes and donor estimated glomerular filtration rate remained significant predictors of cumulative graft survival.
Conclusion:
Kidneys from deceased elderly donors could be a valuable source.
Proper donor selection based on eGFR may ensure better posttransplant function and better graft survival.
Better HLA-DR-matched kidneys will produce better outcomes.
Proper immunologic manipulation to avoid acute rejection episodes with their effects on the reduction of the nephron mass is essential.
Due to organ shortages, the expansion of organ donation criteria is essential. The implementation of expanded criteria donors increased the number of elderly to young donation. Donors who were previously deemed unsuitable are now considered suitable.
The provided study focused on the risk factors associated with kidney donation from elderly deceased donors.
All recipients who received a kidney from a dead donor aged 60 or older at the Sheffield Kidney Institute between 1969 and 2009. A total of 112 donors were enrolled in the study; more than half of them were females (52.7%). The mean age of donors was 64.71 +-4.00 years. Of the 112 recipients, 33.9% were females.
When other donor characteristics such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are considered, there is no significant association between donor age and transplant outcomes.
Similarly, the cold ischemia period, recipient comorbidities, and the total number of HLA antigen mismatches had no meaningful short- or long-term connection with graft survival.
The prevalence of DGF was elevated (40.2%).The incidence of AR was significant (33.9%) as a result of DGF and decreased immunosuppressive treatment. There was a significant decrease in the long-term survival of kidney grafts following delayed graft function, with no effect on patient life. The correlations between donor eGFR and transplant outcome have been underreported in general. The focus has been on the age of donors. Acute rejection episodes showed detrimental effects on transplant survival.
In conclusion, Kidneys from older deceased donors could be a beneficial supply if risk factors are avoided. Appropriate donor selection based on eGFR may result in improved posttransplant performance and graft survival. Kidneys with higher HLA-DR compatibility will produce better outcomes. Appropriate immunologic modulation is required to avoid the deleterious consequences of acute rejection events and their effects on nephron mass decrease.
1.Please provide a summary of this article Introduction
·A wide gap exists between the numbers of ESRD cases on the DKD waiting lists & the number of deceased donors available.
-This fact has dictated the use of ECD for donation.
·Donor age was reported to have adverse effect on graft survival in most studies.
·Patient survival in the 1st & 2ndyear post-transplant were similar between ECD & SCD
donors.
·However, graft survival & function were reduced with increased incidence of DGF & AR
events.
·DGF & AR events are reported as risk factors for graft failure (Ferrer et al).
·Some studies reported that there is no significant relation between donor age & 5-year
graft function.
·So, donors previously deemed as not suitable are now acceptable.
·This retrospective single center study reports outcomes of patients transplanted by kidneys from elderly donors (=/> 60) The study Population
All patients who received DKD grafts from elderly donors (=/> 60 at SKI between 3/1969 & 2/2009.
Exclusion criteria:
DKD transplants from donors < 60 years.
LKD transplants of any donor age.
Transplants before 3/1969 or after 2/ 2009. Aim
To determine graft & patient survival outcomes of kidney transplants from elderly donors. Donor factors:
Age
Sex
Serum creatinine
eGFR
CIT
HLA mm
HLA-DR only mm
Total follow-up,
Total duration of graft survival
Graft & recipient survival at 1, 3, & 5 years post-transplant
AR episodes Recipient factors:
Patient status (dead or alive)
Age
Sex
Co-morbidities (CVD, T2DM type 2, CVD, &HTN)
Type of IS agents used
Number of AR events
DGF
eGFR (MDRD equation) at 3, 12, & 60 months post-transplant.
Graft loss or non-graft survival was defined by a creatinine rise requiring RRT.
Recipient death was defined as non-patient survival.
Statistical analyses done with SPSS Software. Results
·A total of 112 TX were done during the study period.
·Total number of donors: 112 donors.
·59 of the donors are females (52.7%).
·Mean donor age: 64.71 +/- 4.
·Of 112 recipients, 38 are females (33.9%).
·Patient survival at 1 yr was 91.9%, at 3 yrs 82.1 %, & at 5 yrs 78.2%.
·Graft survival at 1 yr was 80.4%, at 3 yrs 67.7%, & at 5 yrs 63.6%.
·Donor age ( P = .008) & donor serum creatinine level (P = .011) were significantly associated with total duration of graft survival.
·Age differences (P = .001), donor eGFR (P = .04), & donor age (P = .03) are
predictors of total duration of graft survival. Donor eGFR & age had negative impact on
graft survival.
·Better cumulative graft survival was associated with the use of kidneys from donors with
eGFR of 60 mL/min as compared to those with eGFR <60 mL/min.
·In a multivariate analysis donor age was not a significant predictor duration of graft survival (P> .05), while AR events (P< .001) & donor eGFR (P = .035) significantly predicted cumulative graft survival. Discussion
·Expanding the criteria for deceased donors ECD was dictated shortage of donor organs
for kidney transplant.
·Graft function was independent of age of the donor.
·The authors found no significant effect of donor age when considered with other donor variables (e.g. kidney function) & donor-recipient variables (DGF & AR).
·CIT, recipient co-morbidity, & total number of HLA mm are also not associated with any
short or long term effect on graft survival.
·Opelz et al. (data from Collaborative Transplant Study) reported that HLA mm
significantly affected the outcome of kidney transplants.
·Reisaeter et al.(655 non-sensitized recipients of DD grafts):
-1-yr HLA-DR m graft survival 90% vs 82% & 73% for 1 & 2 HLA-DR mm grafts.
– 5-yr survival rates were 76%, 62%, & 56%.
– HLA-A & HLA-B did not improve overall graft survival but improved graft survival at 1yr.
·Moreira et al. (997 DD kidney transplants) reported an incidence of DGF of 19%.
·DGF was quite high (40.2%) in the current study; this may indicate that kidneys from
elderly donors are more susceptible to DGF.
·Moreira et al. also report that DGF significantly reduced long-term graft survival without
any effect on patient survival.
·In this study, DGF had no long-term effect in the elderly donors who were > 60 yrs.
·Donor eGFR has significant associated with duration of graft survival.
The significant association between eGFR & graft survival may indicate that the quality of donor kidneys (eGFR) is more important than age.
·Ferrari et al. showed no significant effect of age difference on patient & graft survival in LDK transplant; however, the current study shows that age difference predicts graft survival. This may indicate a role for age difference in DKD transplants in the presence of other risk factors.
·High incidence of AR episodes in the study (33.9%) could be due to the high incidence of DGF or to reduction of IS therapy done to help the elderly kidneys recover from DGF.
·Patient survival in the study is comparable with other single center survival results. Conclusions
·Deceased elderly donors kidneys may significantly expand the donor pool if the
associated risk factors are avoided.
·Better donor selection based on eGFR is related to better post-transplant function &
better graft survival.
·Better HLA-DR m kidneys gives better outcome.
Summary of this article
Introduction
Expansion of the criteria for organ donation is crucial to over come long wating list of deceased donor kidney.
Some of the studies concluded that donor age affect graft survival ,however graft survival affected more by delay graft function and acute rejection .
Some of the reports mention that ,there is no statistical significant corelation between donor age and 5 year graft survival function so this review focus on transplant outcomes of patients who received kidney from elderly donors > or more 60 at a single centre.
Methods
A retrospective study of all recipient who had deceased -donor kidney transplant. With donor age 60 year and above, between march 1969 and feb 2009.
The inclusion criteria :
Deceased -donor transplant from donor >60 or more.
Kidney transplant between 1969 and 2009.
The following donor criteria ,determined graft and patients survival outcome of kidney transplant from elderly donors:
Donor age .
Sex.
Serum creatinine level.
eGFR.
Cold ischemia time .
The donor age categories:
60 to 64 years old .
65 to 69 years old.
>70 or more years old.
Result
Donor characteristic: 112 transplant done during study time and there were 112 donors with mean age 64.7+or_4 years.
112 recipient ,patients survival at 1,3,5 years was 91.9%,82% and 78% respectively .
Graft survival at 1,3 and 5 year was 80.4%,67.7% and 63.6% respectively.
Discussion
This study concludes that no significant association in the donor age and kidney function.
Also cold ischemia time ,recipient co morbidities and Antigen mismatch had no significant association with graft survival in short or long term.
In this study delay graft function did not predict long term outcome in general population,
In this study there were ahigh incidence of acute rejection in this study .
conclusion
proper donor selection should be based on eGFR , better HLA-DR matched kidney and avoid graft rejection result on better graft out come .
Summary of the article Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes
This is a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009.The authors studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
Study Results and Outcome
1. Graft function has been found to be independent of age of the donor. 2. This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration. 3. Cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term. 4. Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival. Better HLA-DR matched kidneys will produce better outcomes.
this article was for a retrospective study for evaluation of risk factors associated with adverse outcome in renal transplant recipients whose donors were elderly deceases ones.
the study included 112 recipients who were studied for the effect of some possible risk factors on the short-term and long-term graft survival. these possible risk factors were as following:
1- donor & recipient ages and age differences
2- HLA-antigen mismatch and HLA-DR mismatch.
3- donor S. creatinine level.
4- cold ischemia time.
5- acute rejection (AR) episodes.
6- delayed graft function (DGF).
the results were as following :
1- the mean age of donors was 64.7 +/- 4 and that of recipients was 50.3 +/- 13.7 years.
2- DGF occurred in 40.2 % and AR episodes occurred in 38 % of patients.
3- graft survival was 80.4 % at 1 year, 63.6 % at 2 years and 82.1 % at 3 years.
4- patient survival was 67.7 % at 1 year, 91.9 % at 2 years and 78.2 % at 3 years.
5- significant predictors of poor graft outcome were :
a- AR episodes
b- low GFR at donation.
6- insignificant predictors of poor graft outcome were :
a- donor age.
b- total HLA mismatch.
c- cold ischemia time.
d- recipient comorbidities.
e- DGF
Conclusion :
1- to achieve reasonable graft survival, the main risk factors are GFR at time of donation and AR episodes. these 2 factors should be avoided as long as possible.
2- good graft function and proper handling of immunosuppression for managing AR episodes are the cornerstone of deceased graft transplantation
But the donors were all deceased
no living donors included!,,,,
Hadeel Badawi
2 years ago
Please provide a summary of this article.
In era of organ shortage, the imbalance between the organ supply and the increases in demand has made an expansion of organ donation criteria and accepting more older donors. Studies reported donor age has an adverse effect on graft survival.
Aim of the study: to evaluated risk factors that could adversely affect outcomes from elderly deceased donor
transplants.
Materials and Methods: Design; single center retrospective study (112 patients). Study period: between March 1969 and February 2009 Inclusion: all recipients who had deceased-donor kidney transplants, with donor age 60 years and above during the study period.
-Donor and recipient factors that might affect graft and patient survival outcomes were determined.
– Donor ages were categorized as follows: 60 to 64 years old, 65 to 69 years old, and ≥ 70 years old.
– Graft loss or non-graft survival was defined as a rise in serum creatinine level requiring renal replacement therapy of any sort within the first week of transplant
-Death of recipient was considered as nonpatient survival
Results:
The mean donor age was 64.71 years, 52.7 %were female
The mean ages of recipients were 50.39 years, 33.9% were females
Patient survival 91.9% at 1 year, 82.1 %, at 3 years, and 78.2% at 5-year.
Graft survival 80.4% at 1 year, 67.7% at 3 years, 63.6% at 5-year
Delayed graft function was reported in 40.2%, whereas acute rejection episode rate was 38%.
Donor age and donor serum creatinine level were significantly correlated with total duration of graft survival.
Donor eGFR ≥ 60 mL/min produced better outcomes than those < 60 mL/min
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome, whereas acute rejection episodes and donor eGFR remained significant predictors of
cumulative graft survival.
Conclusions:
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
Ø The rising global prevalence of chronic kidney disease has increased the number of patients. Kidney transplant is superior to dialysis in terms of quality of life and long-term mortality risk
Ø Objectives: evaluate risk factors that affect outcomes from elderly decease donor Transplants.
Ø A retrospective study of all recipients who had deceased-donor kidney transplants, donor age 60 years, (112 patients)
Ø we studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
Ø Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 21, IBM Corporation, Armonk, NY, USA).
Results
Ø Donor characteristics: there were 112 donors. Fifty-nine of the donors were females (52.7%). The mean donor age was 64.71 } 4.00 years. B
Ø Recipient characteristics 112 recipients, thirty-eight were females (33.9%)
Ø Patient survival At one year, patient survival was 91.9%. At three years, patient survival was 82.1 %,
Ø Graft survival At one year, graft survival was 80.4%. At three years, graft survival was 67.7, whereas 5-year graft survival was 63.6%.
Ø Delayed graft function was 40.2%, acute rejection episode rate was 38%.
Ø Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Ø Cold ischemia time, recipient co-morbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Ø Acute rejection episode was an independent pre – dictor of graft outcome (β level = 2.857, t test = 2.3, P = .025).
Ø Donor age was a predictor of total graft survival duration (log-rank test gave chi-square test with two df = 12.292, P = .002).
Ø Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min (log-rank test gave chi-squared test with 1 df = 7.213, P = .007).
Ø Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes (hazard ratio 5.443;
Ø Conclusions: The risk factors should be avoided to achieve better graft survival. Emphasis should be on more than donor age. Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.
Introduction
Globally, there is rising demand for kidney for those on the diseased donor waiting list, and this led to what is called expanded criteria to accommodate acceptance of more kidney that might have been rejected. However, there is also a growing concern on increase rate of DGF and graft rejection with long term survival in graft from the expanded criteria. Nevertheless, some studies have reported that there is no significant different in 1- and 3-years graft survival from older diseased donor
Aim
to explore transplant outcome of a recipient who received kidney from an elderly patient (i.e., > 60 years)
Materials and Methods
retrospective study involving diseased donor above 60 years in a single centre between March 1969 to February 2009
demographic, clinical, and laboratory data were retrieved to determine the graft and patient survival
age was classified into 60 – 64, 65-69, and > 70 years
graft survival was done at 1, 3, and 5 years
no of episodes of rejection, DGF with eGFR calculated by MDRD
statistical analysis was done with SPSS version 21.
Result
112 diseased kidney donors done under the year reviewed with 52.7% women
the mean age of the donors was 64.71 _+ 4.00 years
of 112 recipients, 33.9% were female
patient survival at 1, 3, and 5 years were 91.9%, 82.1%, and 78.2%
graft survival and 1, 3, and 5 years were 80.4%, 67.7%, and 63.6%
donor age and eGFR negatively predict graft survival
kidney from those> 70 years have the highest cumulative survival
using cox regression, acute rejection episodes and donor eGFR were significant predictor of graft survival.
Conclusion
The selection of graft from elderly donor based of GFR, good immunological manipulation, and HLA-DR matched donor will not only prevent multiple rejection episodes but enhance graft survival.
Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes.
Most of previous studies shown that donor age has an adverse effect on graft survival also graft survival and function were significantly worse with increased incidence of delayed graft function and acute rejection episodes. Materials and Methods:
This is a single center retrospective study conducted on 112 with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009, they studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival. Results.
– The 112 transplants, 59% were female & mean donor age was 64.71 ± 4.00 years.
– Graft survival rates were 80.4% and 67.7%, 63.6% and patient survival rates were 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
– Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
– Donor eGFR and age negatively predicted graft survival.
-Donors with e GFR >60 ml/min have better outcome than those with e GFR<60 mil/min.
-Donor age and delayed graft function were not significant predictors of graft outcome but Rejection attacks and e GFR considered significant predictors of cumulative graft survival. Conclusion:
Kidneys from deceased elderly donors could be a valuable source and age itself is not be considered a risk factor for patient and graft survival. We should select donors based on eGFR may ensure better post-transplant function and subsequently better graft survival and good immunologic matching to avoid the adverse effects of acute rejection episodes as it affect the graft survival.
Previous studies reported poor outcome with higher incidence of acute rejection episodes and DGF in the recipients receiving a deceased elderly donor kidney, but the patient survival at 1 and 3 years after transplantation was comparable to those receiving standard donor kidney
This is a retrospective study evaluating 112 transplant recipients who received elderly (≥ 60 years) deceased donor kidney regarding the impact of acute rejection, DGF, HLA mismatches, donor/recipient age mismatch, cold ischemia time, recipient comorbidities, and donor GFR on graft survival
Results:
More than one third of the recipients developed DGF
More than one third of the recipients developed acute rejection episode
Graft survival was 80.4%, 63.6%, and 82.1% at 1, 3, and 5 years
Patient survival was 67.7%, 91.9%, and 78.2% at 1, 3, and 5 years
From mentioned risk factors only donor GFR (< 60 ml/min) and acute rejection episodes significantly affect graft survival
Other risk factors including DGF, HLA mismatches, donor/recipient age mismatch, cold ischemia time, and recipient comorbidities were not found to alter graft survival
Conclusions:
Focusing on the donor age alone as a risk factor for poor recipient outcome is not always true
The most important risk factors associated with poor graft survival in a recipient of an elderly donor are donor GFR < 60 ml /min and acute rejection episodes, so it is recommended to avoid donor kidneys with GFR < 60 ml /min and to adjust recipient immunosuppression to avoid rejection
Aim of the study :
the single-centre study, they assessed risk variables for elderly deceased donor transplants.
Material and methods:
In this single-centre retrospective study (112 patients), we studied acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
Results:
112 donors participated in the study’s 112 transplants. 52.7% of donors were women. Donors averaged 64.71 4.00 years old. Out of a total of 112 recipients, there were 38 females or 33.9% of the total.
Patient survival
At one year, the survival rate for patients was 91.9%. Survival rates for patients were higher after three years (82.1%), but at five years (78.2%), they were lower.
Graft survival
The graft had a survival rate of 80.4% after one year. Survival rates for grafts at three years were 67.7%, while survival rates at five years were 63.6%.
Discussion:
This research found no significant connection between donor age and donor-recipient characteristics (delayed graft function and acute rejection events). Cold ischemia period, recipient comorbidities, and total HLA antigen mismatches showed no effect on short- or long-term graft survival.33.9% of patients had acute rejection. This may be linked to delayed graft function.
Conclusions
Donated kidneys from older people who have died could be useful, as long as the above risks are not taken. If the right donor is chosen based on eGFR, the graft may work better after the transplant and live longer. Better HLA-DR matches will lead to better results. It is important to use the immune system in the right way to avoid the bad effects of acute rejection episodes, which can cause the nephron mass to shrink.
Please provide a summary of this article
Cohort retrospective observational study i Sheffield kidney institute from Marsh, 1969- February 2009, in deceased donors > 60 years.
Primary outcomes : both at 1,3, and 5 years.
Graft survival.
Patient survival.
Variables- Donor age, sex, serum creatinine level,estimated GFR, and cold ischemia time.
Recepient dead or alive, age, sex, comorbidities, type of immunosupression used, acute rejection episodes (proved by biopsy), delayed graft function, and eGFR at 3,12, and 60 months post Tx.
Results:
Graft survival was 80.4% in 1st year, 67.7% at 3 years, and 63.6% at 5 years post Tx.
Patient survival was 91.9% at 1st year,82.1% at 3 years, and 78.2% 5 years post Tx.
Donor age and serum creatinine correlate significantly to graft survival, by multivariate Cox regression analysis the donor age did not affect graft survival.
Recepient age, acute rejection episodes, and type of CNI used correlate with graft survival significantly.
HLA antigen mismatch did not affect graft survival.
Acute rejection and donor eGFR are predictors of overall graft and patient survival.
Cold ischemia time and delayed graft function did not correlate with graft survival.
Conclusion:
kidneys form elderly deceased donor>60 year old can be a good source for transplantation, in order to achieve better graft survival donors creatinine, recepient age , use of immunosupressive medication used and target therapeutic level are the cornerstone for improving graft survival.
· The current study aimed to evaluate many factors as: donor creatinine at time of donation, cold ischemia time, donor age, degree of HLA mismatch on the incidence of DGF, acute rejection.
· Donor age was independent risk factor for long term graft survival in addition to donor GFR<60 ml/min/m2. However, Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
· Acute rejection was associated with poor graft outcome, so appropriate choice of immunosuppressive medications plays a crucial role in determining the graft outcome.
· use of old age donor to increase donor pool and due to comparable outcomes between standard and expanded criteria donors.
· This retrospective study included old cadaveric donors > 60 years, (112 recipients of cadaveric kidney transplantation) and compared the graft outcomes.
· The current study concluded that older age of the donor was not associated with poor graft outcome. in addition, degree of HLA mismatch and cold ischemia time had no effect on graft survival. This was against conclusion from previous studies.
· Acute rejection incidence was high due to reduction of immunosuppression use in order to help recovery of this old cadaveric kidney.
· As a conclusion, use of elderly cadaveric donor has good outcome with certain prerequisites as:
o Better HLA matched donor with avoidance of HLA-DR mismatch
o Minimization of cold ischemia time.
o Proper choice of IS (tacrolimus instead of cyclopsorin)
o induction therapy to allow delayed start of CNI (to decrease risk of DGF).
Using ECD for kidney donation is increasing to overcome the shortage of donor pool. This retrospective cross sectional study, including 112 kidney transplants from elderly deceased donors , evaluated the impact of some risk factors (donor age , GFR , degree of HLA Ag mismatch ..) on graft outcome ( DGF , AR and duration of graft survival ) .
The graft survival at 1 ,3 and 5 years was 84 % , 67 % and 64% respectively , where DGF and AR were encountered in 40 and 38 %respectively and they had negative impact on graft survival while donor age and GFR >60 ml / min correlated with longer graft survival and function.
Donor age has no significant impact on graft outcome when other risk factors for kidney dysfunction were taken in consideration indicating that quality of the donated kidney ( assessed by eGFR) is more significant than donor age. also cold ischemia time, recipient comorbidies and degree of HLA mismatch have no significant effect on graft survival .
Conclusion:
Elderly deseased donors are valuable source for kidney grafts with comparable graft function and outcome when risk factors as donor GFR are taken into consideration
The number of deceased donors has made expansion of the criteria for organ donation inevitable .
Most studies have indicated that donor age has an adverse effect on graft survival, However, kidneys from very young donors are also associated with poor outcome, likely related to technical complications and graft thrombosis .
In this study ,112 transplants performed during the study period, there were 112 donors, Fifty-nine of the donors were females (52.7%). The mean donor age was 64.71 ± 4.00 years,Of 112 recipients, thirty-eight were females (33.9%) .
At 1 year, patient survival was 91.9%. At 3 years, patient survival was 82.1 %, whereas 5-year patient survival was 78.2% .
At 1 year, graft survival was 80.4%. At 3 years, graft survival was 67.7%, whereas 5-year graft survival was 63.6% .
The study showed that cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival in either the short or long term .
They reported a high incidence of acute rejection episodes about (33.9%),This could be related to the reported high incidence of delayed graft function,It may also be due to reduction of immunosuppressive therapy in an attempt to help the elderly kidneys recover from delayed graft function.
conclusion,proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival; better HLA-DR matched kidneys will produce better outcomes. Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
● Expansion of the criteria for organ donation inevitable due to organ shortage
● DGF and AR are risk factors for graft failure
● there is no statistical significant correlation between donor age and 5-year graft function.
● Donors who were previously considered as not ideal are now considered to be suitable.
Materials and Methods
all recipients who had deceased-donor with age 60 years and above, at Sheffield Kidney Institutu between 1969 and 2009.
● 112 donors. females (52.7%).
● Mean donor age was 64.71 ± 4.00 years. ● 112 recipients. females (33.9%)
● There are no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables(delayed graft function and acute rejection episodes) are taken into consideration.
● Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term
● Incidence of DGF was high (40.2%).
● Incidence of AR was high (33.9%) due to DGF and reduction of immunosuppressive therapy
● a significant reduction in long-term graft survival of kidneys after delayed graft function without any effect on patient survival.
● The associations between donor eGFR and transplant outcome have been generally underreported. The emphasis has been on donor age.
Acute rejection episodes demonstrated adverse effects on graft survival
● Kidneys from deceased elderly donors could be a valuable source with avoiding risk factors
● Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival
● better HLA-DR matched kidneys will produce better outcomes.
● Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
This is a retrospective study done at Sheffield Kidney Institute between March 1969 and 2009, including all kidney transplant from deceased donor > 60 years old.
The study aimed to explore transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above) at a single centre.
Graft and recipients’ survival are determined by the following factors: donor age, sex, sCr level, eGFR, and CIT.
Recipients’ factors: patient status, age, sex, comorbidities, Type of immunosuppressant used, number of acute rejection episodes, DGF, and eGFR at 3, 12, and 60 months after transplantation.
Donor age categorizes as follow;(60-64), (65-69), (and >70) years old.
Donor/Recipients factors; HLA MM, HLA-DR only MM, Total follow-up, Total duration of graft failure, Graft, and Recipient survival at 1, 3, 5, years’ post-transplant.
All rejections are registered and biopsy-based diagnosis.
The study showed:
So, it is concluded that:
IV. Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes
Please provide a summary of this article
The aim:
*To estimate risk factors that could negatively affect the outcomes from elderly deceased donor transplants.
Introduction:
*The large gap between patients on the deceased-donor kidney wait list and the number of deceased donors has made expansion of the criteria for organ donation inevitable.
*Many studies showed that donor age has an adverse effect on graft survival, but kidneys from very young donors are also associated with poor outcome, may be due to technical complications and graft thrombosis.
*The patient survival at the end of the first and third year PKT were comparable between expanded criteria donors and standard criteria donors; however, graft survival and function were significantly worse with increased incidence of (DGF) and acute rejection episodes.
*There is no statistical significant correlation between donor age and 5-year graft function, so donors who were previously considered as not ideal are now considered to be suitable.
The methods:
* Single center retrospective study (112 patients), they studied the effect of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient co morbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
The results:
* Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years.
* Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%.
*Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years. Cold ischemia time, recipient co morbidity, and total HLA antigen
mismatch did not significantly affect graft outcome.
*Acute rejection episode was an independent predictor of graft outcome.
* Donor age was a predictor of total graft survival duration ( P = .002).
* Donor estimated glomerular filtration rates ≥ 60 mL/min produced
better outcomes than those < 60 mL/min (P = .007).
*Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes( P < .001) and donor estimated glomerular filtration rate (hazard ratio 0.449; 95% P = .035) remained significant predictors of cumulative graft survival.
Conclusions
*Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors mentioned above are avoided.
* Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival; better HLA-DR matched kidneys will produce better outcomes. *Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
Please provide a summary of this article
This is a retrospective study of at Sheffield kidney center between March 1969- March 2009.
Aim: assess the outcomes of recipients received renal transplants from elderly donors aged 60 years and above.
Study population:
Renal Transplant Recipients received DD from donors aged 60 years or above at Sheffield kidney center between March 1969- March 2009.
Results:
Patient survival: 91.9% at 1 year, 82.1% at 3 years, and 78.2 % at 5 years.
Graft Survival: 80.4% at 1 year, 67.7% at 3 years, and 63.6% at 5 years.
Donor’s age and e-GFR were negative predictors of graft survival.
Total number of HLA mismatches, cold ischaemia time, and recipient comorbidity had no significant association with short-term and long-term graft survival.
Conclusion:
Graft outcomes are affected more by donor’s e-GFR than donor’s age.
The less HLA mismatches, and lower incidence of acute rejection, the better the graft outcomes.
Introduction:
Most studies have indicated that donor age has an adverse effect on graft survival. However, kidneys from very young donors are also associated with poor outcome, likely related to technical complications and graft thrombosis.
The study explore transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above) at a single center.
Materials and Methods:
A retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 200
Graft and patient survival outcomes of kidney transplants from elderly donors by retrieving the following:
Donor factors: donor age, sex, serum creatinine level, estimated glomerular filtration rate (eGFR), and cold ischemia time.
The following recipient factors were also obtained: patient status (dead or alive), age, sex, comorbidities (cardiovascular disease, type 2 diabetes mellitus, cerebrovascular disease, and hypertension), type of immunosuppressants used, and number of acute rejection episodes, DGF, and eGFR at 3, 12, and 60 months after transplant.
Donor ages were categorized as follows: 60 to 64 years old, 65 to 69 years old, and ≥ 70 years old.
The following donor recipient factors were obtained:
HLA antigen mismatches, HLA-DR only mismatches.
Total follow-up, total duration of graft survival, and graft and recipient survival at 1, 3, and 5 years after transplant.
. The acute rejection episodes were as reported in hospital records. All of the episodes were confirmed by kidney allograft biopsy.
Delayed graft function was defined as the need for dialysis within the first week of transplant.
The eGFR was obtained MDRD.
Predictive analysis of graft survival with univariate analysis:
Donor age and donor serum creatinine level were significantly correlated with total duration of graft survival.
Discussion:
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration. Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or the long term.
The incidence of delayed graft function in our study was quite high (40.2%). This may indicate susceptibility of kidneys from elderly donors to delayed graft function.
It is noteworthy that the donor eGFR in this study was significantly associated with total duration of graft survival and was an independent predictor of cumulative survival even when other donor, recipient, and donor-recipient factors were taken into consideration.
High incidence of acute rejection episodes in this study (33.9%).
Conclusions:
Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors mentioned above are avoided.
Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival; better HLA-DR matched kidneys will produce better outcomes.
Due to the demand-supply gap for renal transplant, need of using elderly donors (expanded criteria donors) for kidney transplant has arisen. The graft and patient outcomes in such cases need evaluation.
This was a retrospective study undertaken to evaluate the risk factors affecting outcomes of elderly (>60 year) deceased donor renal transplants at a single centre (Sheffield Kidney Institute) between 1969 and 2009. The patient and graft survival were determined by assessing donor age, gender, serum creatinine, eGFR and cold ischemia time. Recipient factors like age, total HLA mismatch, HLA-DR mismatch, and comorbidities were also assessed. Acute rejection episodes and delayed graft function (DGF) were recorded.
A total of 112 donors (59 females) were included. They were found to have patient survival of 91.9%, 82.1%, and 78.2% at 1-, 3-, and 5-years post-transplant. The corresponding figures for graft survival were 80.4%, 67.7%, and 63.3%. Donor age and eGFR negatively predicted graft survival. Donors with eGFR <60 ml/min had poorer graft survival than those with higher eGFR. Donor age was not significant predictor of total duration of graft survival while donor eGFR and acute rejection episodes were significant predictors of cumulative graft survival. It signifies that the quality of the donor kidney (eGFR) is more important than the donor age.
Cold ischemia time, total HLA mismatch and recipient co-morbidities did not have association with graft survival. Number of HLA-DR mismatch was associated with poorer graft survival. Although DGF was 40.2% in the study, it had no effect on long-term outcomes. Age difference predicted graft survival.
To conclude, donor selection based on eGFR is more important factor for graft outcomes than the donor age. Better HLA-DR matched kidneys and avoiding acute rejection episodes by optimal immunosuppression help in achieving better graft outcomes.
The objective of this study is evaluate the risk factors associated with elderly donors and poor outcomes.
Its a retrospective single center study, from 1969 to 2009, it included deseased donors age 60 years or more.
It included elderly donors to see there survival which was 91.9%, 82.1%, and 78.2% out of 112 transplants at one , three and five years respectively. graft survival 80,4%, 67.7% and 63.6% at 1, 3 , and 5 years.
It was seen kidney from donors 70 years and older has the best cumulative survival, however, in multivariant analysis there was no difference.
This study showed that the age is not related to patient or graft survival it relates to eGFR.
So the conclusion is that elderly donors could be much valuable source of organ.
Shortage of organs from deceased donors in a cadaver program highlights the importance of organ retrieval from elder donors (>60 years) and even Donor after cardiac death (DCD)…Previous studies have shown no difference in patient survival after 1 and 5 years after transplants in extended criteria donor and Standard criteria donor….But the studies do show an overall poor graft survival in extended criteria donors with increase in the incidence of DGF and Acute rejections….Before this study they were many reports that donor age was not statistically significant and not associated with 5 year graft outcome….
This was a retrospective study done in a single center at Sheffield hospital between 1969-2009…The inclusion population were the donors > 60 years ago..The exclusion criteria was donors <60 years and those with live related transplant ….
112 donors were included in the study.. Majority (59) of them were females and the mean age of donors were 64 + 4 years… Among the 112 recipients, 38 were female recipients… DGF was reported in 40.2% of the recipients…Acute rejection episodes were 38%….Patient survival was 91%,82% and 78% at 1,3 and 5 years respectively…Graft survival was 80%, 67% and 63% at 1,3 and 5 years respectively…The univariate analysis model gives different results when assessed….Donor age and donor serum creatinine correlated with graft survival…Donor eGFR and age negatively predicted graft survival when analyzed as univariate analysis….Kaplan Meir Model of survival analysis showed that use of donor eGFR>60ml/min produced better overall graft survival as compared to those eGFR<60ml/min….Multivariate cox regression analysis show that donor eGFR and acute rejection episodes and not donor age was predictive of the overall cumulative graft survival….
this retrospective analysis shows that quality of donor kidneys based on eGFR is a better predictive of overall graft survival than donor age….proper selection of donors based on eGFR and less HLA DR mismatches and immunological management to avoid rejection episodes should be attempted
there are reports concluding that there is no statistical significant correlation between donor age and 5-year graft function. Therefore, donors who were previously considered as not ideal are now considered to be suitable
-Donor characteristics In the 112 transplants performed during the study period, there were 112 donors. Fifty-nine of the donors were females (52.7%). The mean donor age was 64.71 ± 4.00 years.
-Recipient characteristics Of 112 recipients, thirty-eight were females (33.9%).
-Patient survival At 1 year, patient survival was 91.9%. At 3 years, patient survival was 82.1 %, whereas 5-year patient survival was 78.2%.
-Graft survival At 1 year, graft survival was 80.4%. At 3 years, graft survival was 67.7%, whereas 5-year graft survival was 63.6%.
Multivariate Analyses of Total Duration of Graft Survival (Dependent Variable) and Donor, Recipient, and Recipient-Donor Variables (Independent Variables)
Acute rejection episodes
Delayed graft function
Age difference
HLA-DR only mismatch
HLA antigen mismatch
Comorbidity in recipients
Cold ischemia time
eGFR in categories
Donor age in categories
Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors mentioned above are avoided. Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival; better HLA-DR matched kidneys will produce better outcomes. Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
Organ shortage is a real issue which needs to be addressed and each transplant program is trying their best to overcome this issue.According to OPTN data around 92000 patients are on waiting list and each year almost 10000 are either dying or getting too sick to get a transplant. Accepting elderly donor can be a way to increase donor pool. The authors of this paper have tried to see the impact of utilizing elderly deceased donors on graft outcome.
This was a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009.
In this single center retrospective study (112 patients), they studied the impact of
acute rejection episodes,
delayed graft function,
donor-recipient age differences,
HLA-DR mismatches,
HLA antigen mismatches,
recipient comorbidities,
cold ischemia time,
donor and recipient age,
and donor serum creatinine level on short- and long-term graft survival.
Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years.
Delayed graft function was 40.2%,
whereas acute rejection episode rate was 38%. Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Acute rejection episode was an independent pre- dictor of graft outcome
Donor age was a predictor of total graft survival duration.
Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min.
Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes and donor estimated glomerular filtration rate remained significant predictors of cumulative graft survival.
Conclusion. Age should not be a limiting factor while assessing deceased kidney donation and graft outcome is comparable if donors are selected appropriately
Objectives:
To evaluate risk factors associated with elderly donor and poor outcome.
Materials and Methods:
This is retrospective single center study. It included deceased donors age 60years or more, from 1969 to 2009 at Sheffield Kidney Institute.
Results:
112 transplants from elderly donors were included in the study period.
Patient survival was 91.9%, 82.1% and 78.2% at one, three and five years respectively.
Graft survival was found to be 80.4%, 67.7% and 63.6% at one, 3years and 5years respectively.
Donor age and serum creatinine were significantly associated with duration of graft survival.
Kidneys from donors 70years or old has shown the best cumulative survival, however in multivariate analysis there was no difference.
Discussion
Shortage of organs led to use of expanded criteria donor. Kidneys from elderly donors showed good survival almost like younger donors. This study showed that age is not related to patient or graft survival also.
Conclusions
This study showed that elderly donors could be valuable source for deceased organs provided that it is selected properly specially preserved GFR.
Introduction
· To expand the criteria for organ donation, elderly donors were accepted.
· patient survival at the end of the first and third year after transplant were comparable between expanded criteria donors and standard criteria donor
Materials and Methods
· Inclusion criteria: deceased-donor transplants from donors ≥ 60 years old and kidney transplant that occurred between March 1969 and February 2009
· Exclusion criteria:
1- deceased-donor transplants from donors < 60 years old
2- living-donor transplants of any donor age
3- deceased- or living-donor transplants before March 1969 or after February 2009
· All of the episodes of acute rejection were confirmed by kidney allograft biopsy, reported in hospital records
· Delayed graft function was defined as the need for dialysis within the first week of transplant.
· MDRDe used to estimate GFR
Results
· 52.7% of the 112 donors were females, and the mean donor age was 64.71 ± 4.00 years
· 33.9% of 112 recipients, were females
· Patient survival at 1, 3, and 5 years, was 91.9%, 82.1 %, and 78.2% respectively.
· Graft survival at 1,3, and 5 years, was 80.4%, 67.7%, and63.6%, respectively.
Discussion
· Graft function has been found to be independent of age of the donor
· Cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches had no significant association with graft survival, in either the short or long term
· While Opelz and associates, found that HLA antigen mismatches significantly influenced the outcome of kidney transplants
· The incidence of delayed graft function in this study was high (40.2%), could be due to susceptibility of kidneys from elderly donors to delayed graft function
· But, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old
· The quality of donor kidneys (ie, donor eGFR) might be more important than donor age
· The high incidence of acute rejection episodes in this study (33.9%), could be related to the delayed graft function, or due to reduction of immunosuppressive drugs
· cold ischemia time was not significantly associated with overall graft survival in this study
Conclusions
· Elderly deceased donation is accepted with no risk factors
· The outcome and graft survival depends on eGFR before donation
· Better HLA-DR matched kidneys have better outcomes
· Avoidance of acute rejection with the proper immunosuppressive drugs, to reduce nephron mass
This is a single center retrospective study on 112 patients who received kidneys from elderly deceased donors age 60 years or above at Sheffield kidney institute between March 1969 and February 2009 evaluating the risk factors of poor outcome.
The donor factors : donor age, sex, serum creatinine level, estimated glomerular filtration rate (eGFR), and cold ischemia time.
The recipient factors:
patient status (dead or alive), age, sex, comorbidities
(cardiovascular disease, type 2 diabetes mellitus,
cerebrovascular disease, and hypertension), type of
immunosuppressant used, number of acute
rejection episodes, DGF, and eGFR at 3, 12, and 60
months after transplant.
HLA antigen mismatches, HLA-DR only mismatches, total
follow-up, total duration of graft survival, and graft
and recipient survival at 1, 3, and 5 years after transplant.
Reports of the acute rejection biopsies results were taken.
The results:
Patient survival : 1 year, patient survival was 91.9%, 3 years patient survival was 82.1 %, whereas 5-year patient
survival was 78.2%.
Graft survival : 1 year, graft survival was 80.4%, 3 years graft survival was 67.7%, whereas 5-year graft survival was 63.6%.
Thus graft function is expected to be good when other risk factors are not present and proper donor, immunosuppression usage and better HLA-DR matched kidneys.
Please provide a summary of this article
Many studies have indicated that kidney donation from old donor may be associated with poor outcomes and other studies have found poor outcomes when donor is young due to technical complications and graft thrombosis. Studies have also shown that outcome at 1 and 3 year was comparable between standard and expanded criteria donors.
Objective of study
To evaluate the risk factors associated with poor outcomes in elderly kidney donors.
Methodology
Retrospective study evaluated the short and long term graft survival by looking at effect of -acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level.
Results-
Acute rejection rate was 38%
DGF in 40%
Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Donor age not an important predictor of outcome
Donation with eGFR > 60 ml had better outcomes as compared to those with eGFR <60 ml
Donor age and eGFR were directly related to cumulative graftoutcomes.
Conclusion
Emphasis should not be on donor age only but factors leading to poor outcomes should be avoided . Both good donor kidney function and proper immune suppression are tools to achieve better outcomes.
summary:
kidney disease is in arise and such there must be ways to receive donors to decrease the demand. This article is about kidneys from deceased elderly donors, and factors associated with adverse outcomes. The study explored the outcomes of patients that received kidneys from older donors. The study is a retrospective one of all the recipients who received deceased donors with a donor age of 60 years and above. The study was conducted at the Sheffield Kidney institute from a period of 1969-2009.
The criteria for donor selection are that the deceased donor transplant age must be greater than 60 years and above and from a period of March 1969 to February 2009.
The criteria for not including deceased donor transplantation is donors less than 60 years, living donor transplantation of any age, and anyone from before March 1969 and after February 2009.
From the above, the following results were obtained that there were 112 recipients and 112 donors.
– It was noted that donors with a GFR greater than 60 ml/min did better than those less than that GFR.
-Having acute rejection episodes and donor GFR was important as it relates to cumulative graft survival.
-Age was not a factor as it relates to total graft survival and donor age and DGF were not significant predictors of the graft outcome.
In the study, there was no significant association as regards donor age when other donor-recipient factors are considered. There were high DGRs that can be related to elderly donors. It was found that acute rejection was high and it may be related to the high incidence of DGF or possible immunosuppression reduction.
So in conclusion, one can say that the better the GFR the better will be the recipient graft survival. Receiving a kidney from a deceased donor is a great source of the donation. If the kidneys are properly matched that is their HLA-DR, the better will be the graft survival. Having better drugs to prevent rejection that is a better protocol is likely to directly influence on graft survival and its outcome.
Currently as there is small numbers of donors available for kidney transplantation especially deceased donors ,So there is urgent need to expand the criteria to accept donors ,
This paper aims at not having a cutoff limit in donor age as other factors can affect graft and patient survival more than Age
Methedology:
112 patients deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009
they studied other factors that can affect graft and patient survival like:
1-No. of acute rejection episodes
2- Incidence of delayed graft function,
3- Donor-recipient age differences
4-HLA-DR mismatches ,HLA antigen mismatches
5- Recepient comorbidities
6- Cold ischemia
7- Donor and recepient age
8- Donor serum creatinine level
They addressed all these factors impact on short- and long-term graft survival.
I
Results:
1-Delayed graft function was 40.2% but it did not have significant effect on graft outcome
2- Acute rejection episode rate was 38% which was independent predictor of graft outcome.
3-Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
4- Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
5-Donor age was a predictor of total graft survival duration but not significant predictor of graft outcome .
6-Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min.
They found no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration. cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
Discussion:
Comparison to other studies done in this issue:
1-Moreira and associates reported delayed graft function of 19% among 997 deceased-donor kidney transplants.23 The incidence of delayed graft function in our study was quite high (40.2%).and has significant effect on long term survival of the graft ,in this study high incidence of DGF but there was no effect on long term graft outcome .
2-Other studies reviewed effect of donor age on living donors but still no more studies on Deceased donor age and this makes the basis of Eurotransplant Senior Program that was started in 1999.
So they concluded that that other factors should be considered in correlation of donor age to graft survival like Epsiodes of acute rejection and delayed graft function which may change the current thinking and expand the pool of accepted deceased donor for kidney transplant .
There is a need to expand the criteria for organ donation due to the long waiting time on the list. One of the most important criteria has to do with age. The article attempts to study the risk factors that could adversely affect outcomes from elderly deceased-donor transplants.
A retrospective study was carried out, where all recipients of deceased donors over 60 years of age in the period between 1969 and 2009 and the donor-recipient factors were obtained: HLA antigen mismatches, HLA-DR only mismatches, total follow-up, total duration of graft survival, and graft and recipient survival at 1, 3, and 5 years after transplant.
Among the results I highlight::
– At 1 year, patient survival was 91.9%. At 3 years, patient survival was 82.1 %, whereas 5-year patient survival was 78.2%.
– At 1 year, graft survival was 80.4%. At 3 years, graft survival was 67.7%, whereas 5-year graft survival was 63.6%.
– univariate analysis concluded that donor age and donor serum creatinine level were significantly correlated with total duration of graft survival
– multiple regression model showed that: age differences, donor eGFR, and donor age are independent predictors of total duration of graft survival, where donor eGFR and age negatively predicted graft survival.
– Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival;
So, the factor for a more appropriate choice related to an eldery donor is a, associated with the lowest possible age. After that, only HLA-DR matched kidneys will produce better outcomes, as they will lead to a choice of immunosuppressants with less risk of adverse effects and failure with graft rejection.
A retrospective study conducted to emphasize on the adverse features that compromise the long term survival of the elderly deceased donor renal allograft.
112 recipients involved. Donors age ranged from 64-+4 years in Sheffield medical institute from 1969 through 2009{ it principally investigated the outcome of transplanting a kidney from a deceased donor of above 60 year of age}.
Parameters considered in this study include:
Age of donors, sex, creatinine and glomerular filtration rate ,cold ischemia time,
Recipients criteria includes: patient survival,age and sex.
Comorbidities: Cerebrovascular disease, cardiovascular disease, type 2 diabetes mellitus and hypertension. immunosuppressants used, number of acute rejection episodes, delayed graft function and eGFR at 6, 12 and 60 months.
Donors ages categorized into 3 groups 60-64, 65-69 and above 70.
Donors, recipients features were highlighted accordingly:
1-HLA antigens mismatchs
2-HLA-DR antigen only mismatch
3-total duration of graft survival.
4-recipient and allograft survival at 1. 3 and 5 years.
Delayed graft function was elucidated as : The need for dialysis in the first week post transplantation.
Acute rejection was featured as per the hospital records and based on allograft biops7 findings.
eGFR was explicated by MDRD .
Non graft survival or graft loss : was interpreted as rise in serum creatinine that required renal replacement for any underlying etiology in the first week post transplant.
Results:
Graft survival was 80% , 67% and 63% at 1, 3 and 5 years .
The graft survival was significantly correlated to donors age and serum creatinine .
eGFR of more than 60 ml/min was correlated with better allograft survival then those with e GFR of less than 60 ml/min.
Acute rejection episodes were linked to worse graft survival , which is indicating the diminished nephron mass endowed to elderly deceased kidneys which would be further lost by the repeated acute rejection episodes . Donor age was not significantly associated with allograft survival. Acute rejection episodes were reported to be higher incidents in those patients , This basically pertinent to the practice of reducing the immunosuppression for potential enhancement of DGF recovery ..Therefore, optimization of anti rejection protocol is one of the main recommendations put forth by this study.
With the burden of ESRD, the optimal RRT is renal transplantation. With an exponential increase in patients on the waiting list, the need for deceased and ECD is prominent. It is known that graft function is affected adversely with the increase in donor age. In this study, 112 patients were evaluated as we can see in figures 2&3 (Kaplan Meier survival analysis), there is a prominent difference in outcome (better in age under 60). Multivariate analysis showed a nonsignificant effect of the donor’s age; in contrast, acute rejection episodes and donor age were associated with graft survival. Donors with eGFR less than 60 ml/min had worse outcomes than grafts retrieved from donors with eGFR>60 ml/min.
introduction
this study explored transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above) at a single center.
a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009
inclusion criteria :
were deceased-donor transplants from donors ≥ 60 years old and kidney transplant that occurred between March 1969 and February 2009.
excluded criteria :
deceased-donor transplants from donors < 60 years old, living-donor transplants of any donor age, and deceased- or living-donor transplants before March 1969 or after February 2009
results :
the use of kidneys from donors with eGFR of 60 mL/min produced better cumulative graft survival than those with eGFR less than 60 mL/min
donor age was not a significant predictor of total duration of graft survival
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration. Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
the study shows high incedince of acute graft rejection .
limitation :
immunosuppression protocols was changed in our unit from cyclosporine based to tacrolimus based in 2002. This had no effect on the message conveyed in this study as it addresses the various risk factors that could adversely lower graft survival regardless of the immunosuppressive agents used. Also, cold ischemia time was not significantly associated with overall graft survival in our study
In general rather than donor age Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.
Results:
Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years.
Delayed graft function was 40.2%
acute rejection episode rate was 38%
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min
—————————————-
studies have shown that patient survival at the end of the first and third year after transplant were comparable between expanded criteria donors and standard criteria donors; however, graft survival and function were significantly worse with increased incidence of delayed graft function DGF) and acute rejection episodes.
In addition, there are reports concluding that there is no statistical significant correlation between donor age and 5-year graft function. Therefore, donors who were previously considered as not ideal are now considered to be suitable.
Discussion
The acute shortage of donor organs for kidney transplant has necessitated the expansion of criteria for deceased donors in many institutions. The extended criteria donor has been well defined.
>>> Despite many criticisms against the use of kidneys from elderly donors, graft function has been found to be independent of age of the donor.
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
Again our study, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old.
The quality of donor kidneys (ie, donor eGFR) might be more important than donor age.
Conclusions
Please provide a summary of this article
Studies have shown that patient survival at the end of the first and third year after -transplant were comparable between expanded criteria donors and standard criteria donors .
-Graft survival and function were significantly worse with increased incidence of delayed graft function (DGF) and acute rejection episodes.
-There are reports concluding that there is no statistical significant
correlation between donor age and 5-year graft function. Therefore, donors who were previously considered as not ideal are now considered to be suitable.
– It was a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute
between March 1969 and February 2009.
-The acute shortage of donor organs for kidney transplant has necessitated the expansion of criteria for deceased donors in many institutions.
-There is no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
-Cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
– The incidence of delayed graft function in the study was quite high (40.2%). This may indicate susceptibility of kidneys from elderly donors to delayed graft function.
-In the study, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old.
-There was no reference to definitive measure of the association between the eGFR and graft survival.
-Age difference might have a role in kidneys from deceased donors in the presence of other risk factors .
-It may be due to reduction of immunosuppressive therapy in an attempt to help
the elderly kidneys recover from delayed graft function.
-Acute rejection episodes demonstrated adverse effects on graft survival. This result may be due to reduced nephron mass of these donor kidneys.
-Proper donor selection based on eGFR and better HLA-DR matched kidneys will
produce better outcomes.
Summary
This study reveals the factors associated with adverse outcomes when using kidneys from deceased elderly kidney donors.
The given study estimates that many factors that are usually considered to have a massive effect on graft outcome are not the major ones in case of elderly donors. These include cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches.
Delayed graft function from reduced immunosuppression can have an effect on graft function. Increased number of acute rejection episodes can result from reduced immunosuppression, and this can further affect graft outcome. This result is due to the reduced nephron mass of the donor kidneys .
The study concludes with the following recommendations :
This retrospective single center study explored transplant outcomes of patients who received kidneys from elderly donors (aged 60 years and above).
Population of study;
• All recipients who had DD kidney transplants, with donor age 60 years and above,
• at Sheffield Kidney Institute
• between March 1969 and February 2009.
Excluding criteria
1. deceased-donor transplants from donors < 60 years old,
2. living-donor transplants of any donor age,
3. deceased- or living-donor transplants before March 1 969 or after February 2009.
following recipient factors were obtained:
• patient status (dead or alive)
• age
• sex
• comorbidities
• (CVD, type 2 DM, and hypertension)
• type of immunosuppressants used number of acute rejection episodes
• DGF
• eGFR at 3, 12, and 60 months after transplant.
Patient survival
• At I year, was 91.9%.
• At 3 years, patient survival was 82.1 %,
• whereas 5-year patient survival was 78.2%.
Graft survival
• At I year, was 80.4%.
• At 3 years, was 67.7%,
• whereas 5-year graft survival was 63.6%.
Predictive analysis of graft survival with univariate analysis Donor age and donor serum creatinine level were significantly correlated with total duration of graft survival.
They compared duration of graft survival as the dependent variable. With The independent variables included total HLA antigen mismatch, HLA-DR mismatch, recipient comorbidities, cold ischemia time, age differences, DGF, acute rejection episodes, donor eGFR, and donor age.
The result that Donor eGFR and age negatively predicted graft survival.
However, This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
Similarly cold ischemia time, recipient comorbidity and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
Conclusion
1. Kidneys from deceased elderly donors could be a valuable source, provided that the risk factors are avoided.
2. Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival,
3. better HLA-DR matched kidneys will produce better outcomes.
4. Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
Excellent well organized summary
– This study evaluates the risk factors that could adversely affect outcomes from elderly deceased donor transplants.
– In this single center retrospective study (112 patients) , the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival were studied ..
– It demonstrated that demonstrated there is no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
– Also in this study, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old.
– donor eGFR in this study was significantly associated with total duration of graft survival and was an independent predictor of cumulative survival even when other donor, recipient, and donor-recipient factors were taken into consideration.
Conclusion :
– Kidneys from deceased elderly donors could be a
valuable source, so, Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival, also, better HLA-DR matched kidneys will produce better outcomes.
– Proper immunologic assessment to avoid the adverse effects of acute
rejection episodes which will impact the outcome.
Well done
Please provide a summary of this article
Introduction
Donor age has an adverse outcome in most studies. Patient survival was comparable between ECD and SCD but graft survival and function were significantly affected with DGF and acute rejection
Studies comparing donor age with graft function were inconclusive
Aim of the study: retrospective descriptive study to evaluate the outcomes (graft and patient survival) of patients who received kidneys from elderly donors (aged 60 years and above)
Materials and Methods
All recipients who were received kidneys from deceased elderly donors (aged 60 years and above) in one center (Sheffield Kidney Institute between1969 and 2009)
Donor factors:
1. Donor age: categorized 60-64, 65-69, and ≥ 70 years old (The mean donor age was 64.71 ± 4.00 years)
2. Sex (52.7% were female)
3. Serum creatinine level
4. eGFR
5. Cold ischemia time
Recipient factor:
1. Patient status (dead or alive)
2. Age (mean age 50.39 ± 13.72)
3. Sex (33.9% were female)
4. Comorbidities (CV disease, type 2 DM, CVA, and HTN)
5. Type of immuno suppressants used
6. Number of acute rejection episodes
7. DGF
8. eGFR at 3, 12, and 60 months after transplant
Donor- recipient factors:
1. HLA antigen mismatches
2. HLA-DR only mismatches
3. Total follow-up
4. Total duration of graft survival
5. Graft and recipient survival at 1, 3, and 5 years after transplant
Acute rejection: all were confirmed with allograft biopsy
DGF: need for dialysis within the first week of transplant
eGFR: (MDRD equation)
Graft loss or nongraft survival: rise in serum creatinine requiring RRT within the first week of transplant
Results
There were 112 recipients and 112 donors
Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years
Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome
Donor age was not a significant predictor of total duration of graft survival
Donor age and DGF were not significant predictors of graft outcome
Kidneys from donors with eGFR of 60 mL/min produced better cumulative graft survival than those with eGFR less than 60 mL/min
Acute rejection episodes and donor eGFR were significant predictors of cumulative graft survival
Discussion
In this study, no significant association regarding donor age when other donor-recipient factors are considered
In this study there was high DGF (40.2%). May be due to DGF from the elderly donors
Also the incidence of acute rejection episodes was high (33.9%). This could be related to the high incidence of DGF or immunosuppression reduction
Conclusion
Kidneys from deceased elderly donors are useful if risk factors are avoided
Donor selection based on eGFR and better HLA-DR matched kidneys will produce better outcomes.
Excellent
This is a retrospective study which had involved all deceased donors aged 60 and above in Sheffield Kidney Institute in the period 1969 – 2009. It focused on the adverse outcome associated with kidney grafts from deceased elderly donors. At 1 year, patient survival was 91.9% which dropped after 5-year to 78.2%. Graft survival at 1 year was 80.4% and by 5 years it was 63.6%. graft survival was significantly associated with donor age , donor serum creatinine and the age difference between donor and recipient. donors age 70 years and older had the highest cumulative survival but multivariate analyses of cumulative graft survival as a function of donor age after correcting for acute rejection episodes, delayed graft function, and donor estimated glomerular filtration rate, donor age and dgf were not significantly association with cumulative graft survival using this model .
This study demonstrates that , in elderly donors, there is no significant association between graft survival and cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches which contradict many studied conducted in the other different age groups .
Honda please revise the article and organize the answers
Shortage of donor pool resulted in expanding the criteria for accepting donors, factors with adverse effects on graft survival were studied and showed that patient survival was similar in both expanded criteria donors and standard criteria donors.
Previous studies showed that graft function was independent of age of donor while DGF and acute rejection episodes were associated with worse graft outcome.
This study aimed to determine the outcome of kidney transplantation from elderly donors >60 years.
It was a retrospective study, included 112 deceased donor transplants with donors >60 years, donors were categorized according to age into 60-64 years, 65-69 years and >70 years.
The study showed that donor age was not significantly associated with graft outcome, also cold ischemia, recipient comorbidities and HLA mismatch were not associated with graft survival.
The incidence of delayed graft function was 40.2% indicating susceptibility of kidneys from elderly donors to delayed graft function but it was not a predictor of long-term outcome in elderly donors.
eGFR was significantly associated with duration of graft survival and was an independent predictor of survival indicating that quality of donor kidney was more important than donor age.
Age difference between donor and recipient predicted graft survival and may have a role in kidneys from deceased donor.
The incidence of acute rejection episodes was also high in this study and were associated with adverse effects on graft survival.
The patient survival in this study was similar to other single center studies
Cold ischemia time was not significantly associated with graft survival.
Proper donor selection based on eGFR may ensure better post transplant function and better graft survival and better HLA-DR matched kidneys will result in better outcome.
Proper selection of kidneys from deceased donors with avoiding risk factors can increase donor pool with similar outcome as living donors.
Well done
As we need for donor to reduce the burden of ESRD and global implications ,expanded criteria for donation which is include older age for donation.
Aretrospective study was done in Sheffield from 1969 to 2009 found that
Kidneys from deceased elderly donors could be a valuable source.
Proper donor selection based on eGFR may ensure better posttransplant function and better graft survival.
Better HLA-DR-matched kidneys will produce better outcomes.
Proper immunologic manipulation to avoid acute rejection episodes with their effects on the reduction of the nephron mass is essential.
this found to have no association between donor age and graft survival ,so we can accept older age for donation but still there is eGFR is directly related to the total graft survival .
Good conclusion but some details are needed to reach them
This is a single-center retrospective cohort study collecting data related to kidney transplantation from an elderly deceased donor (over 60 years of age) from March 1969 to February 2009. This study separated into three age groups (60 to 64; 65 to 69 and over 70 years) and evaluated a range of clinical and immunological outcomes.
The study evaluated 112 donors in this period, with a mean age of 64.71 years, where most donors were women (52.7%) and most recipients were men (66.1%). Patient survival was 91.9% (1 year), 82.1% (3 years) and 78.2% (5 years). The graft survived 80.4%, 67.7%, and 63.6% respectively in the same period. Donors with better eGFR (>60mL/min) had a better outcome. Age difference and younger donors also had more favorable outcomes.
In this study, late graft response was considered high (around 40%), but an important finding is that the quality of the donor (eGFR > 60mL/min) may be higher and more important than the age of the donor itself. . Other findings such as HLA DR match and good immunological correlation decrease the risk of rejection and increase graft survival.
Thankyou
This is retrospective study of all recipients who have deceased donor kidney transplantation with donor age 60 years or above.
Outcome of kidney transplant from elderly donors done by following donor factors:
Donor age
sex, s.creatinine level, e GFR and cold ischaemia time.
The following recipient factors, age, sex, comorbidities and hypertension.
Delayed graft function was 40.2%, acute rejectin rate was 38%. Graft and patient survival rates were 80.4% and 67.7% and 91.9% and 82.1% and 78.2% and 78.2% at 1,3 and 5 years.
Donor age was was a predictor of total graft survival duration.
Cold ischaemia time, recipient co morbidity and total HLA antigen mismatch did not significantly affect graft function.
Then what were the concluded factors most effective in this article
Summary of the article:
As the number of ESKD patients are globally increased, and the need of organ donation are also increased, so increase organ donation by increasing donor pool are highly required, as kidney transplant considered the best modality treatment of kidney failure.
Material and methods:
Results:
Donor charaecteristics:
Recipients charecteristics:
D/R factors:
Patient survival; at 1 yrs was 91.9%, At 3 yrs82.15, At 5 yrs 78.2%.
Graft survival At 1 yrs was 80.4%, At 3 yrs was 67.7%, At 5 yrs was 63.65.
Total duration of graft survival was significantly associated with donor age and serum Cr.
Use donor kidney with eGFR >60 had better survival than those with eGFR < 60.
kidneys from donor’s age >70 had better cumulative survival rate .
Discussion:
increasing need for kidney for donation necessitated ECD in many institutions
Graft survival was found to be independent from donor age and so expanding criteria for donation as in the past donation from older age was unfavorable.
No significant association between donor age and other D/R variables
In contrast Opelz conclude that HLA MM had a direct association with graft survival
Comparing high percentage of DGF with other study involving younger donor may reflect the association between older donor age and DGF
Donor eGFR were significantly associated with total duration of garft survival even if we put other variables in consideration
High incidence of graft rejection may be associated with high rate of DGF
Conclusion :
kidney from deceased donors is a good source of donation
Better eGFR selection associated with better survival
Better HLA-DR matched kidny also asociated with better outcome
Better immunolgic manipulation to ensure less rejection episodes and hence longer graft survival and outcome
Very good
Summary:
Aim of the study:
To evaluate risk factors that could adversely affect outcomes from elderly deceased donor transplants.
Methods:
A retrospective study.
Recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009.
The inclusion criteria: deceased-donor transplants from donors ≥ 60 years old and kidney transplant that occurred between March 1969 and February 2009.
The exclusion criteria: deceased-donor transplants from donors < 60 years old, living-donor transplants of any donor age, and deceased- or living-donor transplants before March 1969 or after February 2009.
The impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival were studied.
Results:
The mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years. Delayed graft function rate was 40.2%.
Acute rejection episode rate was 38%.
Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Acute rejection episode was an independent predictor of graft outcome.
Donor age was a predictor of total graft survival duration.
Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min.
Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome, whereas acute rejection episodes and donor estimated glomerular filtration rate remained significant predictors of cumulative graft survival.
Conclusion:
Kidneys from deceased elderly donors could be a valuable source.
Proper donor selection based on eGFR may ensure better posttransplant function and better graft survival.
Better HLA-DR-matched kidneys will produce better outcomes.
Proper immunologic manipulation to avoid acute rejection episodes with their effects on the reduction of the nephron mass is essential.
Well done
Due to organ shortages, the expansion of organ donation criteria is essential. The implementation of expanded criteria donors increased the number of elderly to young donation. Donors who were previously deemed unsuitable are now considered suitable.
The provided study focused on the risk factors associated with kidney donation from elderly deceased donors.
All recipients who received a kidney from a dead donor aged 60 or older at the Sheffield Kidney Institute between 1969 and 2009. A total of 112 donors were enrolled in the study; more than half of them were females (52.7%). The mean age of donors was 64.71 +-4.00 years. Of the 112 recipients, 33.9% were females.
When other donor characteristics such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are considered, there is no significant association between donor age and transplant outcomes.
Similarly, the cold ischemia period, recipient comorbidities, and the total number of HLA antigen mismatches had no meaningful short- or long-term connection with graft survival.
The prevalence of DGF was elevated (40.2%).The incidence of AR was significant (33.9%) as a result of DGF and decreased immunosuppressive treatment. There was a significant decrease in the long-term survival of kidney grafts following delayed graft function, with no effect on patient life. The correlations between donor eGFR and transplant outcome have been underreported in general. The focus has been on the age of donors. Acute rejection episodes showed detrimental effects on transplant survival.
In conclusion, Kidneys from older deceased donors could be a beneficial supply if risk factors are avoided. Appropriate donor selection based on eGFR may result in improved posttransplant performance and graft survival. Kidneys with higher HLA-DR compatibility will produce better outcomes. Appropriate immunologic modulation is required to avoid the deleterious consequences of acute rejection events and their effects on nephron mass decrease.
Well done
1.Please provide a summary of this article
Introduction
·A wide gap exists between the numbers of ESRD cases on the DKD waiting lists & the number of deceased donors available.
-This fact has dictated the use of ECD for donation.
·Donor age was reported to have adverse effect on graft survival in most studies.
·Patient survival in the 1st & 2ndyear post-transplant were similar between ECD & SCD
donors.
·However, graft survival & function were reduced with increased incidence of DGF & AR
events.
·DGF & AR events are reported as risk factors for graft failure (Ferrer et al).
·Some studies reported that there is no significant relation between donor age & 5-year
graft function.
·So, donors previously deemed as not suitable are now acceptable.
·This retrospective single center study reports outcomes of patients transplanted by kidneys from elderly donors (=/> 60)
The study
Population
All patients who received DKD grafts from elderly donors (=/> 60 at SKI between 3/1969 & 2/2009.
Exclusion criteria:
DKD transplants from donors < 60 years.
LKD transplants of any donor age.
Transplants before 3/1969 or after 2/ 2009.
Aim
To determine graft & patient survival outcomes of kidney transplants from elderly donors.
Donor factors:
Age
Sex
Serum creatinine
eGFR
CIT
HLA mm
HLA-DR only mm
Total follow-up,
Total duration of graft survival
Graft & recipient survival at 1, 3, & 5 years post-transplant
AR episodes
Recipient factors:
Patient status (dead or alive)
Age
Sex
Co-morbidities (CVD, T2DM type 2, CVD, &HTN)
Type of IS agents used
Number of AR events
DGF
eGFR (MDRD equation) at 3, 12, & 60 months post-transplant.
Graft loss or non-graft survival was defined by a creatinine rise requiring RRT.
Recipient death was defined as non-patient survival.
Statistical analyses done with SPSS Software.
Results
·A total of 112 TX were done during the study period.
·Total number of donors: 112 donors.
·59 of the donors are females (52.7%).
·Mean donor age: 64.71 +/- 4.
·Of 112 recipients, 38 are females (33.9%).
·Patient survival at 1 yr was 91.9%, at 3 yrs 82.1 %, & at 5 yrs 78.2%.
·Graft survival at 1 yr was 80.4%, at 3 yrs 67.7%, & at 5 yrs 63.6%.
·Donor age ( P = .008) & donor serum creatinine level (P = .011) were significantly associated with total duration of graft survival.
·Age differences (P = .001), donor eGFR (P = .04), & donor age (P = .03) are
predictors of total duration of graft survival. Donor eGFR & age had negative impact on
graft survival.
·Better cumulative graft survival was associated with the use of kidneys from donors with
eGFR of 60 mL/min as compared to those with eGFR <60 mL/min.
·In a multivariate analysis donor age was not a significant predictor duration of graft survival (P> .05), while AR events (P< .001) & donor eGFR (P = .035) significantly predicted cumulative graft survival.
Discussion
·Expanding the criteria for deceased donors ECD was dictated shortage of donor organs
for kidney transplant.
·Graft function was independent of age of the donor.
·The authors found no significant effect of donor age when considered with other donor variables (e.g. kidney function) & donor-recipient variables (DGF & AR).
·CIT, recipient co-morbidity, & total number of HLA mm are also not associated with any
short or long term effect on graft survival.
·Opelz et al. (data from Collaborative Transplant Study) reported that HLA mm
significantly affected the outcome of kidney transplants.
·Reisaeter et al.(655 non-sensitized recipients of DD grafts):
-1-yr HLA-DR m graft survival 90% vs 82% & 73% for 1 & 2 HLA-DR mm grafts.
– 5-yr survival rates were 76%, 62%, & 56%.
– HLA-A & HLA-B did not improve overall graft survival but improved graft survival at 1yr.
·Moreira et al. (997 DD kidney transplants) reported an incidence of DGF of 19%.
·DGF was quite high (40.2%) in the current study; this may indicate that kidneys from
elderly donors are more susceptible to DGF.
·Moreira et al. also report that DGF significantly reduced long-term graft survival without
any effect on patient survival.
·In this study, DGF had no long-term effect in the elderly donors who were > 60 yrs.
·Donor eGFR has significant associated with duration of graft survival.
The significant association between eGFR & graft survival may indicate that the quality of donor kidneys (eGFR) is more important than age.
·Ferrari et al. showed no significant effect of age difference on patient & graft survival in LDK transplant; however, the current study shows that age difference predicts graft survival. This may indicate a role for age difference in DKD transplants in the presence of other risk factors.
·High incidence of AR episodes in the study (33.9%) could be due to the high incidence of DGF or to reduction of IS therapy done to help the elderly kidneys recover from DGF.
·Patient survival in the study is comparable with other single center survival results.
Conclusions
·Deceased elderly donors kidneys may significantly expand the donor pool if the
associated risk factors are avoided.
·Better donor selection based on eGFR is related to better post-transplant function &
better graft survival.
·Better HLA-DR m kidneys gives better outcome.
Excellent
Summary of this article
Introduction
Expansion of the criteria for organ donation is crucial to over come long wating list of deceased donor kidney.
Some of the studies concluded that donor age affect graft survival ,however graft survival affected more by delay graft function and acute rejection .
Some of the reports mention that ,there is no statistical significant corelation between donor age and 5 year graft survival function so this review focus on transplant outcomes of patients who received kidney from elderly donors > or more 60 at a single centre.
Methods
A retrospective study of all recipient who had deceased -donor kidney transplant. With donor age 60 year and above, between march 1969 and feb 2009.
The inclusion criteria :
Deceased -donor transplant from donor >60 or more.
Kidney transplant between 1969 and 2009.
The following donor criteria ,determined graft and patients survival outcome of kidney transplant from elderly donors:
Donor age .
Sex.
Serum creatinine level.
eGFR.
Cold ischemia time .
The donor age categories:
60 to 64 years old .
65 to 69 years old.
>70 or more years old.
Result
Donor characteristic: 112 transplant done during study time and there were 112 donors with mean age 64.7+or_4 years.
112 recipient ,patients survival at 1,3,5 years was 91.9%,82% and 78% respectively .
Graft survival at 1,3 and 5 year was 80.4%,67.7% and 63.6% respectively.
Discussion
This study concludes that no significant association in the donor age and kidney function.
Also cold ischemia time ,recipient co morbidities and Antigen mismatch had no significant association with graft survival in short or long term.
In this study delay graft function did not predict long term outcome in general population,
In this study there were ahigh incidence of acute rejection in this study .
conclusion
proper donor selection should be based on eGFR , better HLA-DR matched kidney and avoid graft rejection result on better graft out come .
Well done
Summary of the article
Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes
This is a retrospective study of all recipients who had deceased-donor kidney transplants, with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009. The authors studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
Study Results and Outcome
1. Graft function has been found to be independent of age of the donor.
2. This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
3. Cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term.
4. Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival.
Better HLA-DR matched kidneys will produce better outcomes.
What are the two significant factors concluded in the study?
IV. Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes
————————————————————————————————————————————————————————————————————————————–
Objectives:
Material , methods and main parameters evaluated:
-This retrospective study (112 patients)
————————————————————————————————————————————————————————————————————————————-
-The following recipients were excluded:
————————————————————————————————————————————————————————————————————————————–
Results:
————————————————————————————————————————————————————————————————————————————–
Conclusions:
Excellent
Please provide a summary of this article :
1- donor & recipient ages and age differences
2- HLA-antigen mismatch and HLA-DR mismatch.
3- donor S. creatinine level.
4- cold ischemia time.
5- acute rejection (AR) episodes.
6- delayed graft function (DGF).
1- the mean age of donors was 64.7 +/- 4 and that of recipients was 50.3 +/- 13.7 years.
2- DGF occurred in 40.2 % and AR episodes occurred in 38 % of patients.
3- graft survival was 80.4 % at 1 year, 63.6 % at 2 years and 82.1 % at 3 years.
4- patient survival was 67.7 % at 1 year, 91.9 % at 2 years and 78.2 % at 3 years.
5- significant predictors of poor graft outcome were :
a- AR episodes
b- low GFR at donation.
6- insignificant predictors of poor graft outcome were :
a- donor age.
b- total HLA mismatch.
c- cold ischemia time.
d- recipient comorbidities.
e- DGF
1- to achieve reasonable graft survival, the main risk factors are GFR at time of donation and AR episodes. these 2 factors should be avoided as long as possible.
2- good graft function and proper handling of immunosuppression for managing AR episodes are the cornerstone of deceased graft transplantation
Well done
Objectives:
To evaluate transplant outcomes of kidneys from elderly donors (> 60 years of age).
Materials and Methods:
Main parameters evaluated:
acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level
Results:
Conclusions
Emphasis should not be on donor age alone.
Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.
Excellent Thankyou
But the donors were all deceased
no living donors included!,,,,
In era of organ shortage, the imbalance between the organ supply and the increases in demand has made an expansion of organ donation criteria and accepting more older donors. Studies reported donor age has an adverse effect on graft survival.
Aim of the study: to evaluated risk factors that could adversely affect outcomes from elderly deceased donor
transplants.
Materials and Methods:
Design; single center retrospective study (112 patients).
Study period: between March 1969 and February 2009
Inclusion: all recipients who had deceased-donor kidney transplants, with donor age 60 years and above during the study period.
-Donor and recipient factors that might affect graft and patient survival outcomes were determined.
– Donor ages were categorized as follows: 60 to 64 years old, 65 to 69 years old, and ≥ 70 years old.
– Graft loss or non-graft survival was defined as a rise in serum creatinine level requiring renal replacement therapy of any sort within the first week of transplant
-Death of recipient was considered as nonpatient survival
Results:
The mean donor age was 64.71 years, 52.7 %were female
The mean ages of recipients were 50.39 years, 33.9% were females
Patient survival 91.9% at 1 year, 82.1 %, at 3 years, and 78.2% at 5-year.
Graft survival 80.4% at 1 year, 67.7% at 3 years, 63.6% at 5-year
Delayed graft function was reported in 40.2%, whereas acute rejection episode rate was 38%.
Donor age and donor serum creatinine level were significantly correlated with total duration of graft survival.
Donor eGFR ≥ 60 mL/min produced better outcomes than those < 60 mL/min
Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome, whereas acute rejection episodes and donor eGFR remained significant predictors of
cumulative graft survival.
Conclusions:
This study demonstrated no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables (delayed graft function and acute rejection episodes) are taken into consideration.
Well done
Ø The rising global prevalence of chronic kidney disease has increased the number of patients. Kidney transplant is superior to dialysis in terms of quality of life and long-term mortality risk
Ø Objectives: evaluate risk factors that affect outcomes from elderly decease donor Transplants.
Ø A retrospective study of all recipients who had deceased-donor kidney transplants, donor age 60 years, (112 patients)
Ø we studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
Ø Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 21, IBM Corporation, Armonk, NY, USA).
Results
Ø Donor characteristics: there were 112 donors. Fifty-nine of the donors were females (52.7%). The mean donor age was 64.71 } 4.00 years. B
Ø Recipient characteristics 112 recipients, thirty-eight were females (33.9%)
Ø Patient survival At one year, patient survival was 91.9%. At three years, patient survival was 82.1 %,
Ø Graft survival At one year, graft survival was 80.4%. At three years, graft survival was 67.7, whereas 5-year graft survival was 63.6%.
Ø Delayed graft function was 40.2%, acute rejection episode rate was 38%.
Ø Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
Ø Cold ischemia time, recipient co-morbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
Ø Acute rejection episode was an independent pre – dictor of graft outcome (β level = 2.857, t test = 2.3, P = .025).
Ø Donor age was a predictor of total graft survival duration (log-rank test gave chi-square test with two df = 12.292, P = .002).
Ø Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min (log-rank test gave chi-squared test with 1 df = 7.213, P = .007).
Ø Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes (hazard ratio 5.443;
Ø Conclusions: The risk factors should be avoided to achieve better graft survival. Emphasis should be on more than donor age. Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.
Excellent
SUMMARY
Introduction
Globally, there is rising demand for kidney for those on the diseased donor waiting list, and this led to what is called expanded criteria to accommodate acceptance of more kidney that might have been rejected. However, there is also a growing concern on increase rate of DGF and graft rejection with long term survival in graft from the expanded criteria. Nevertheless, some studies have reported that there is no significant different in 1- and 3-years graft survival from older diseased donor
Aim
Materials and Methods
Result
Conclusion
The selection of graft from elderly donor based of GFR, good immunological manipulation, and HLA-DR matched donor will not only prevent multiple rejection episodes but enhance graft survival.
Excellent
Kidneys From Deceased Elderly Donors: Factors Associated With Adverse Outcomes.
Most of previous studies shown that donor age has an adverse effect on graft survival also graft survival and function were significantly worse with increased incidence of delayed graft function and acute rejection episodes.
Materials and Methods:
This is a single center retrospective study conducted on 112 with donor age 60 years and above, at Sheffield Kidney Institute between March 1969 and February 2009, they studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
Results.
– The 112 transplants, 59% were female & mean donor age was 64.71 ± 4.00 years.
– Graft survival rates were 80.4% and 67.7%, 63.6% and patient survival rates were 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years.
– Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
– Donor eGFR and age negatively predicted graft survival.
-Donors with e GFR >60 ml/min have better outcome than those with e GFR<60 mil/min.
-Donor age and delayed graft function were not significant predictors of graft outcome but Rejection attacks and e GFR considered significant predictors of cumulative graft survival.
Conclusion:
Kidneys from deceased elderly donors could be a valuable source and age itself is not be considered a risk factor for patient and graft survival. We should select donors based on eGFR may ensure better post-transplant function and subsequently better graft survival and good immunologic matching to avoid the adverse effects of acute rejection episodes as it affect the graft survival.
Well done
Previous studies reported poor outcome with higher incidence of acute rejection episodes and DGF in the recipients receiving a deceased elderly donor kidney, but the patient survival at 1 and 3 years after transplantation was comparable to those receiving standard donor kidney
This is a retrospective study evaluating 112 transplant recipients who received elderly (≥ 60 years) deceased donor kidney regarding the impact of acute rejection, DGF, HLA mismatches, donor/recipient age mismatch, cold ischemia time, recipient comorbidities, and donor GFR on graft survival
Results:
Conclusions:
Excellent
Aim of the study :
the single-centre study, they assessed risk variables for elderly deceased donor transplants.
Material and methods:
In this single-centre retrospective study (112 patients), we studied acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short- and long-term graft survival.
Results:
112 donors participated in the study’s 112 transplants. 52.7% of donors were women. Donors averaged 64.71 4.00 years old. Out of a total of 112 recipients, there were 38 females or 33.9% of the total.
Patient survival
At one year, the survival rate for patients was 91.9%. Survival rates for patients were higher after three years (82.1%), but at five years (78.2%), they were lower.
Graft survival
The graft had a survival rate of 80.4% after one year. Survival rates for grafts at three years were 67.7%, while survival rates at five years were 63.6%.
Discussion:
This research found no significant connection between donor age and donor-recipient characteristics (delayed graft function and acute rejection events). Cold ischemia period, recipient comorbidities, and total HLA antigen mismatches showed no effect on short- or long-term graft survival.33.9% of patients had acute rejection. This may be linked to delayed graft function.
Conclusions
Donated kidneys from older people who have died could be useful, as long as the above risks are not taken. If the right donor is chosen based on eGFR, the graft may work better after the transplant and live longer. Better HLA-DR matches will lead to better results. It is important to use the immune system in the right way to avoid the bad effects of acute rejection episodes, which can cause the nephron mass to shrink.
Excellent
Please provide a summary of this article
Cohort retrospective observational study i Sheffield kidney institute from Marsh, 1969- February 2009, in deceased donors > 60 years.
Primary outcomes : both at 1,3, and 5 years.
Variables- Donor age, sex, serum creatinine level,estimated GFR, and cold ischemia time.
Recepient dead or alive, age, sex, comorbidities, type of immunosupression used, acute rejection episodes (proved by biopsy), delayed graft function, and eGFR at 3,12, and 60 months post Tx.
Results:
Graft survival was 80.4% in 1st year, 67.7% at 3 years, and 63.6% at 5 years post Tx.
Patient survival was 91.9% at 1st year,82.1% at 3 years, and 78.2% 5 years post Tx.
Donor age and serum creatinine correlate significantly to graft survival, by multivariate Cox regression analysis the donor age did not affect graft survival.
Recepient age, acute rejection episodes, and type of CNI used correlate with graft survival significantly.
HLA antigen mismatch did not affect graft survival.
Acute rejection and donor eGFR are predictors of overall graft and patient survival.
Cold ischemia time and delayed graft function did not correlate with graft survival.
Conclusion:
kidneys form elderly deceased donor>60 year old can be a good source for transplantation, in order to achieve better graft survival donors creatinine, recepient age , use of immunosupressive medication used and target therapeutic level are the cornerstone for improving graft survival.
Well done
Summary:
· The current study aimed to evaluate many factors as: donor creatinine at time of donation, cold ischemia time, donor age, degree of HLA mismatch on the incidence of DGF, acute rejection.
· Donor age was independent risk factor for long term graft survival in addition to donor GFR<60 ml/min/m2. However, Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome.
· Acute rejection was associated with poor graft outcome, so appropriate choice of immunosuppressive medications plays a crucial role in determining the graft outcome.
· use of old age donor to increase donor pool and due to comparable outcomes between standard and expanded criteria donors.
· This retrospective study included old cadaveric donors > 60 years, (112 recipients of cadaveric kidney transplantation) and compared the graft outcomes.
· The current study concluded that older age of the donor was not associated with poor graft outcome. in addition, degree of HLA mismatch and cold ischemia time had no effect on graft survival. This was against conclusion from previous studies.
· Acute rejection incidence was high due to reduction of immunosuppression use in order to help recovery of this old cadaveric kidney.
· As a conclusion, use of elderly cadaveric donor has good outcome with certain prerequisites as:
o Better HLA matched donor with avoidance of HLA-DR mismatch
o Minimization of cold ischemia time.
o Proper choice of IS (tacrolimus instead of cyclopsorin)
o induction therapy to allow delayed start of CNI (to decrease risk of DGF).
Well done
Using ECD for kidney donation is increasing to overcome the shortage of donor pool. This retrospective cross sectional study, including 112 kidney transplants from elderly deceased donors , evaluated the impact of some risk factors (donor age , GFR , degree of HLA Ag mismatch ..) on graft outcome ( DGF , AR and duration of graft survival ) .
The graft survival at 1 ,3 and 5 years was 84 % , 67 % and 64% respectively , where DGF and AR were encountered in 40 and 38 %respectively and they had negative impact on graft survival while donor age and GFR >60 ml / min correlated with longer graft survival and function.
Donor age has no significant impact on graft outcome when other risk factors for kidney dysfunction were taken in consideration indicating that quality of the donated kidney ( assessed by eGFR) is more significant than donor age. also cold ischemia time, recipient comorbidies and degree of HLA mismatch have no significant effect on graft survival .
Conclusion:
Elderly deseased donors are valuable source for kidney grafts with comparable graft function and outcome when risk factors as donor GFR are taken into consideration
And acute rejection episodes
Excellent
● Expansion of the criteria for organ donation inevitable due to organ shortage
● DGF and AR are risk factors for graft failure
● there is no statistical significant correlation between donor age and 5-year graft function.
● Donors who were previously considered as not ideal are now considered to be suitable.
Materials and Methods
all recipients who had deceased-donor with age 60 years and above, at Sheffield Kidney Institutu between 1969 and 2009.
● 112 donors. females (52.7%).
● Mean donor age was 64.71 ± 4.00 years. ● 112 recipients. females (33.9%)
● There are no significant association regarding donor age when other donor variables such as kidney function and donor-recipient variables(delayed graft function and acute rejection episodes) are taken into consideration.
● Similarly, cold ischemia time, recipient comorbidity, and total number of HLA antigen mismatches also had no significant association with graft survival, in either the short or long term
● Incidence of DGF was high (40.2%).
● Incidence of AR was high (33.9%) due to DGF and reduction of immunosuppressive therapy
● a significant reduction in long-term graft survival of kidneys after delayed graft function without any effect on patient survival.
● The associations between donor eGFR and transplant outcome have been generally underreported. The emphasis has been on donor age.
Acute rejection episodes demonstrated adverse effects on graft survival
● Kidneys from deceased elderly donors could be a valuable source with avoiding risk factors
● Proper donor selection based on eGFR may ensure better posttransplant function and subsequently better graft survival
● better HLA-DR matched kidneys will produce better outcomes.
● Proper immunologic manipulation to avoid the adverse effects of acute rejection episodes with their effects on reduction of the nephron mass is essential.
Well done