The use of very extended criteria donors has increased in the last few years in relation to the paucity of donors and the increasing age of recipients. However, doubts about their usefulness make the decision about their allocation extremely difficult. Our objective has been to analyze the evolution and survival of kidney transplants performed with kidneys from donors older than 80 years.
Materials and Methods: We compared in a retrospective study kidney transplants from donors older than 80 years (D≥80) versus donors younger than 80 years (D<80) in the last 4 years in our Unit. From January 2012 to December 2016, 258 kidney transplants were performed, 65 % (176) of them with expanded criteria donors, with a mean follow-up of 24,46 ± 18,24 (0-60,9) months.
Results: Nineteen kidney transplants were performed with kidney from D≥80, and 157 with D<80. Mean recipient age in D≥80 group was 68,5 ± 9,8 years vs 60,6 ± 9,8 years in the group of D<80 (p < 0,001). No differences were found about recipient gender between groups (p = 0,43). Mean donor age in D ≥ 80 was 81,8 ± 1,1 years vs 67,5 ± 6,7 years in D<80 (p < 0,001). In D ≥ 80 group, there was a greater proportion of female donors (77,8 % in D≥80 vs 50 % in D<80, p = 0,02). No differences were found in blood pressure (p = 0,636) or cerebrovascular death (p = 0,663). Serum creatinine (mg/dl) was lower in D≥80 group, but without significant differences (0,61 ± 0,18 mg/dl en D≥80 vs 0,80 ± 0,42 mg/dl en D<80, p = 0,078). Delayed graft function was more frequent in D≥80 (p = 0,06) in spite of a shorter cold ischemia time (14,5 ± 6,1 vs 17,8 ± 5,1 hours, p = 0,022). Early acute rejection episodes were similar in both groups (p = 0,537). Renal function was significantly lower in D≥80 during the follow-up. Graft survival was lower in D≥80 (p = 0,041) without differences in patient survival (p = 0,441). Nowadays, 13 of the 19 kidney transplants performed with D≥80 still function, and there has been six graft losses, four of them in the early postoperative period (two graft thrombosis and two primary non-function).
Conclusion: Kidneys from D≥80 have allowed the kidney transplantation of older patients included in the waiting list. However, the high rate of early graft losses reflects their great vascular fragility and their lower capacity to resolve injuries derived from bran death. Therefore, a continuous review of the results obtained with this type or donors is essential.