Limited survival benefit of living versus deceased donor kidney transplantation in elderly recipients

E. Tegzess, A.W. Gomes Neto, R.A. Pol, S.E. de Boer, J.S.F. Sanders, S. P. Berger

Wednesday 4 march 2020

14:30 - 14:40h at Theaterzaal

Parallel session: Parallel sessie III – Klinische abstracts

Background: Increasing numbers of elderly (≥65 years) patients need a kidney transplant. Currently, there is a poignant shortage of deceased donor kidneys, thus putting a strong emphasis on living donation. As waiting time for a deceased donor kidney within the Eurotransplant Senior Program is declining, it is important to understand the strengths and limitations of the different transplantation modalities. This study compares the survival outcome between living donor kidneys (LDK) and deceased donor kidneys (DDK) in elderly recipients.

Methods: This is a single-centre retrospective cohort study of elderly renal transplant recipients transplanted between 2005 and 2017. Primary outcome measures are patient-, graft- and death censored graft survival at 1 and 5 years post-transplantation (post-tx). Multivariate Cox regression analysis was performed to correct for potential confounders such as recipient comorbidity and dialysis vintage. Secondary outcome measures include rejection in the first year and renal function at 1 year post-tx, assessed using the creatinine based CKD-EPI equation to determine eGFR.

Results: In total 369 elderly patients were transplanted, 113 (30.6%) received an LDK and 256 (69.4%) a DDK. 62.5% of recipients were male, median age was 68 years. There is no significant difference in patient survival between LDK and DDK at 1 year (96.3% vs. 92.9%, p=0.202) or at 5 years post-tx (70.2% vs. 65.4%, p=0.534). At 1 year post-tx, graft survival is significantly higher in the LDK group (95.4% vs. 84.1%, p=0.003). At 5 years post-tx the difference is still significant, but remains about 11% (71.0% vs. 59.9%, p=0.017). Death censored graft survival was significantly higher for the LDK group at 1 year (99.1% vs. 89.0%, p=0.001) and 5 years post-tx (97.6% vs. 84.4%, p=0.017). Multivariate cox regression analysis did not alter our findings. The eGFR at 1 year was significantly higher in the LDK group (58.9 vs. 49.6 ml/min, p<0.001). The incidence of treated rejection in the first year did not differ significantly (LDK 14.1% vs. DDK 8.5%, p=0.138).

Conclusions: We conclude that in elderly recipients the patient survival benefits of an LDK compared to a DDK are limited. The lower graft survival in the DDK group is caused mainly by increased death censored graft loss in the first year. Nevertheless, the DDK graft survival remains satisfactory for elderly patients. These findings may support elderly patients, potential living donors and care professionals in choosing the transplant modality.