Benefits of Living Over Deceased Donor Kidney Transplantation in Elderly Recipients. A Propensity Score Matched Analysis of a Large European Registry Cohort
Toapanta, Néstor (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Comas, Jordi (Organització Catalana de Trasplantaments)
Revuelta, Ignacio (Hospital Clínic i Provincial de Barcelona)
Manonelles, Anna (Institut d'Investigació Biomèdica de Bellvitge)
Facundo, Carme (Fundació Puigvert)
Pérez-Sáez, María José (Hospital del Mar (Barcelona, Catalunya))
Vila, Anna (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Arcos, Emma (Catalan Transplantation Organization)
Tort, Jaume (Catalan Transplantation Organization)
Giral, Magali (Université de Nantes)
Naesens, Maarten (University Hospitals Leuven (Bèlgica))
Kuypers, Dirk RJ (Department of Microbiology, Immunology, and Transplantation, KU Leuven)
Åsberg, Anders (University of Oslo. Department of Pharmacy)
Moreso, Francesc (Universitat Autònoma de Barcelona. Departament de Medicina)
Bestard, Oriol (Universitat Autònoma de Barcelona. Departament de Medicina)

Data:	2024
Resum:	Although kidney transplantation from living donors (LD) offers better long-term results than from deceased donors (DD), elderly recipients are less likely to receive LD transplants than younger ones. We analyzed renal transplant outcomes from LD versus DD in elderly recipients with a propensity-matched score. This retrospective, observational study included the first single kidney transplants in recipients aged ≥65 years from two European registry cohorts (2013-2020, n = 4,257). Recipients of LD (n = 408), brain death donors (BDD, n = 3,072), and controlled cardiocirculatory death donors (cDCD, n = 777) were matched for donor and recipient age, sex, dialysis time and recipient diabetes. Major graft and patient outcomes were investigated. Unmatched analyses showed that LD recipients were more likely to be transplanted preemptively and had shorter dialysis times than any DD type. The propensity score matched Cox's regression analysis between LD and BDD (387-pairs) and LD and cDCD (259-pairs) revealing a higher hazard ratio for graft failure with BDD (2. 19 [95% CI: 1. 16-4. 15], p = 0. 016) and cDCD (3. 38 [95% CI: 1. 79-6. 39], p < 0. 001). One-year eGFR was higher in LD transplants than in BDD and cDCD recipients. In elderly recipients, LD transplantation offers superior graft survival and renal function compared to BDD or cDCD. This strategy should be further promoted to improve transplant outcomes.
Ajuts:	Instituto de Salud Carlos III PI19/01710 Instituto de Salud Carlos III PI23/01909 Instituto de Salud Carlos III AC21_2/00050 Instituto de Salud Carlos III AC22/00029
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Living donor ; Deceased donor ; Survival ; Elderly renal transplant ; Propensity score analysis
Publicat a:	Transplant International, Vol. 37 (August 2024) , ISSN 1432-2277

DOI: 10.3389/ti.2024.13452
PMID: 39263600

10 p, 2.1 MB

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