What to do with kidneys from older deceased donors?

The number of patients waiting for a kidney transplant in the United States recently eclipsed 100,000, yet most kidneys recovered from deceased donors aged 65 years or older are discarded.

To investigate how to optimally increase the use of such "expanded criteria donor kidneys," a team led by John Gill MD, MS, Caren Rose, PhD, (University of British Columbia, in Canada), and Elke Schaeffner, MD (Charité University Medicine, in Berlin) conducted a series of analyses of data from the Eurotransplant Senior Program and the United States Renal Data System. They found that in patients in need of a transplant who are at least 60 years old, rapid transplantation from an older deceased donor is superior to delayed transplantation from a younger donor. The researchers also discovered that kidneys from older donors do not have sufficient longevity to provide younger patients with a lifetime of kidney function, but they do have sufficient longevity to provide older patients who have a shorter life expectancy with a lifetime of kidney function.

"Older patients derive a survival benefit from rapid transplantation with an older donor kidney, while younger patients do not derive a benefit from transplantation from an older kidney," said Dr. Gill. "Ensuring older patients can access older donor kidneys should be a priority in the United States. This may involve increased utilization of older donor kidneys or possibly excluding younger patients from receiving these kidneys." Study co-authors include Ulrich Frei, MD and Jagbir Gill MD, MS.

The article, entitled "A Lifetime of Allograft Function with Kidneys from Older Donors," will appear online at http://jasn.asnjournals.org/ on March 26, 2015.