Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: A study by the ERA-EDTA Registry

Maria Pippias; Kitty J. Jager; Anders Åsberg; Stefan P. Berger; Patrik Finne; James G. Heaf; Julia Kerschbaum; Marko Lempinen; Ángela Magaz; Ziad A. Massy; Vianda S. Stel

doi:10.1093/ndt/gfy268

Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: A study by the ERA-EDTA Registry

Maria Pippias^*
, Kitty J. Jager
, Anders Åsberg
, Stefan P. Berger
, Patrik Finne
, James G. Heaf
, Julia Kerschbaum
, Marko Lempinen
, Ángela Magaz
, Ziad A. Massy
, Vianda S. Stel

^*Corresponding author for this work

Medicine (Roskilde)

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.

METHODS: We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.

RESULTS: The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1-24.9]} and young [15.3% (95% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9-41.5)] and young [29.2% (95% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44-0.68)] and 40% [young aHR 0.60 (95% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00-1.04)] or 1% [young aHR 1.01 (95% CI 1.00-1.01)] increase in the 10-year risk of death.

CONCLUSIONS: Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.

Original language	English
Pages (from-to)	534-543
Number of pages	10
Journal	Nephrology Dialysis Transplantation
Volume	35
Issue number	3
DOIs	https://doi.org/10.1093/ndt/gfy268
Publication status	Published - 1 Mar 2020

Funding

We would like to thank the patients and the staff of the dialysis and transplant units for contributing data via their national and regional renal registries. Furthermore, we gratefully acknowledge the following registries and persons for their contributions of data: Austrian Dialysis and Transplant Registry (OEDTR) (R. Kramar); DNS; Dutch Renal Registry (RENINE) (L. Heuveling, S. Vogelaar and M. Hemmelder); Finnish Registry for Kidney Diseases (A. Pylsy and P. H. Groop); Norwegian Renal Registry (T. Leivestad and A. V. Reisæter) and the Spanish regional registries of UNIPAR (J. Aranzabal, M. Rodrigo and I. Moina) and Catalonia (RMRC) (E. Arcos, J. Comas and J. Tort) and the other ERA-EDTA registry committee members not mentioned above for their advice in the analysis and the drafting of this paper: C. Zoccali, F. J. Caskey, C. Couchoud, M. Evans, J. W. Groothoff, J. Harambat, F. Jarraya, M. Nordio and I. Rychlik and A. Kramer in the Academic Medical Center Registry office for data collection and management. We would also like to thank the following transplant registries for supplying data for use in this study: Dutch Transplant Foundation (Cynthia Konijn-Janssen), Scandiatransplant and the Finnish Transplantation Registry. The ERA-EDTA Registry is funded by the ERA-EDTA. This article was written by Pippias et al. on behalf of the ERA-EDTA Registry, which is an official body of the ERA-EDTA.

Keywords

deceased donor
donor age
epidemiology
ERA-EDTA Registry
kidney transplantation
Graft Rejection/epidemiology
Prognosis
Humans
Middle Aged
Graft Survival
Male
Survival Rate
Tissue Donors/statistics & numerical data
Transplant Recipients
Incidence
Young Adult
Kidney Transplantation/adverse effects
Europe/epidemiology
Registries/statistics & numerical data
Adult
Death
Female
Aged

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10.1093/ndt/gfy268

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Pippias, M., Jager, K. J., Åsberg, A., Berger, S. P., Finne, P., Heaf, J. G., Kerschbaum, J., Lempinen, M., Magaz, Á., Massy, Z. A., & Stel, V. S. (2020). Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: A study by the ERA-EDTA Registry. Nephrology Dialysis Transplantation, 35(3), 534-543. https://doi.org/10.1093/ndt/gfy268

@article{096fe85f093146bcac1de96d2211314c,

title = "Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: A study by the ERA-EDTA Registry",

abstract = "BACKGROUND: Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.METHODS: We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.RESULTS: The 10-year cumulative incidence of graft failure was lowest in very young \{22.0\% [95\% confidence interval (95\% CI) 19.1-24.9]\} and young [15.3\% (95\% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7\% (95\% CI 31.9-41.5)] and young [29.2\% (95\% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45\% [very young adjusted hazard ratio (aHR) 0.55 (95\% CI 0.44-0.68)] and 40\% [young aHR 0.60 (95\% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2\% [very young aHR 1.02 (95\% CI 1.00-1.04)] or 1\% [young aHR 1.01 (95\% CI 1.00-1.01)] increase in the 10-year risk of death.CONCLUSIONS: Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.",

keywords = "deceased donor, donor age, epidemiology, ERA-EDTA Registry, kidney transplantation, Graft Rejection/epidemiology, Prognosis, Humans, Middle Aged, Graft Survival, Male, Survival Rate, Tissue Donors/statistics \& numerical data, Transplant Recipients, Incidence, Young Adult, Kidney Transplantation/adverse effects, Europe/epidemiology, Registries/statistics \& numerical data, Adult, Death, Female, Aged",

author = "Maria Pippias and Jager, \{Kitty J.\} and Anders {\AA}sberg and Berger, \{Stefan P.\} and Patrik Finne and Heaf, \{James G.\} and Julia Kerschbaum and Marko Lempinen and {\'A}ngela Magaz and Massy, \{Ziad A.\} and Stel, \{Vianda S.\}",

year = "2020",

month = mar,

day = "1",

doi = "10.1093/ndt/gfy268",

language = "English",

volume = "35",

pages = "534--543",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

number = "3",

}

Pippias, M, Jager, KJ, Åsberg, A, Berger, SP, Finne, P, Heaf, JG, Kerschbaum, J, Lempinen, M, Magaz, Á, Massy, ZA & Stel, VS 2020, 'Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: A study by the ERA-EDTA Registry', Nephrology Dialysis Transplantation, vol. 35, no. 3, pp. 534-543. https://doi.org/10.1093/ndt/gfy268

Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: A study by the ERA-EDTA Registry. / Pippias, Maria; Jager, Kitty J.; Åsberg, Anders et al.
In: Nephrology Dialysis Transplantation, Vol. 35, No. 3, 01.03.2020, p. 534-543.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years

T2 - A study by the ERA-EDTA Registry

AU - Pippias, Maria

AU - Jager, Kitty J.

AU - Åsberg, Anders

AU - Berger, Stefan P.

AU - Finne, Patrik

AU - Heaf, James G.

AU - Kerschbaum, Julia

AU - Lempinen, Marko

AU - Magaz, Ángela

AU - Massy, Ziad A.

AU - Stel, Vianda S.

PY - 2020/3/1

Y1 - 2020/3/1

N2 - BACKGROUND: Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.METHODS: We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.RESULTS: The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1-24.9]} and young [15.3% (95% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9-41.5)] and young [29.2% (95% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44-0.68)] and 40% [young aHR 0.60 (95% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00-1.04)] or 1% [young aHR 1.01 (95% CI 1.00-1.01)] increase in the 10-year risk of death.CONCLUSIONS: Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.

AB - BACKGROUND: Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.METHODS: We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.RESULTS: The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1-24.9]} and young [15.3% (95% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9-41.5)] and young [29.2% (95% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44-0.68)] and 40% [young aHR 0.60 (95% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00-1.04)] or 1% [young aHR 1.01 (95% CI 1.00-1.01)] increase in the 10-year risk of death.CONCLUSIONS: Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.

KW - deceased donor

KW - donor age

KW - epidemiology

KW - ERA-EDTA Registry

KW - kidney transplantation

KW - Graft Rejection/epidemiology

KW - Prognosis

KW - Humans

KW - Middle Aged

KW - Graft Survival

KW - Male

KW - Survival Rate

KW - Tissue Donors/statistics & numerical data

KW - Transplant Recipients

KW - Incidence

KW - Young Adult

KW - Kidney Transplantation/adverse effects

KW - Europe/epidemiology

KW - Registries/statistics & numerical data

KW - Adult

KW - Death

KW - Female

KW - Aged

UR - https://www.scopus.com/pages/publications/85081042750

U2 - 10.1093/ndt/gfy268

DO - 10.1093/ndt/gfy268

M3 - Article

C2 - 30203080

AN - SCOPUS:85081042750

SN - 0931-0509

VL - 35

SP - 534

EP - 543

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 3

ER -

Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: A study by the ERA-EDTA Registry

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