Benefits of Living Over Deceased Donor Kidney Transplantation in Elderly Recipients. A Propensity Score Matched Analysis of a Large European Registry Cohort
Por:
Toapanta, N, Comas, J, Revuelta, I, Manonelles, A, Facundo, C, Pérez-Saez, MJ, Vila, A, Arcos, E, Tort, J, Giral, M, Naesens, M, Kuypers, D, Asberg, A, Moreso, F, Bestard, O
Publicada:
23 ago 2024
Resumen:
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. [Graphical Abstract]
Filiaciones:
Toapanta, N:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Barcelona Hosp Campus, Vall dHebron Res Inst VHIR,Kidney Transplant Unit,, Barcelona, Spain
Comas, J:
Catalan Transplantat Org, Barcelona, Spain
Revuelta, I:
Hosp Clin Barcelona, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Manonelles, A:
Barcelona Univ UB, Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Nephrol Dept,Kidney Transplant Unit, Barcelona, Spain
Facundo, C:
Fundacio Puigvert, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Pérez-Saez, MJ:
Hosp Mar, Nephrol Dept, Kidney Transplant Unit, Barcelona, Spain
Vila, A:
Hosp Univ Germans Trias i Pujol, Nephrol Dept, Kidney Transplant Unit, Badalona, Spain
Arcos, E:
Catalan Transplantat Org, Barcelona, Spain
Tort, J:
Catalan Transplantat Org, Barcelona, Spain
Giral, M:
Univ Nantes, CHU Nantes, CRTI UMR 1064, ITUN,CRTI,UMR 1064,RTRS Centaure, Nantes, France
Naesens, M:
Katholieke Univ Leuven, Dept Microbiol Immunol & Transplantat, Leuven, Belgium
Kuypers, D:
Katholieke Univ Leuven, Dept Microbiol Immunol & Transplantat, Leuven, Belgium
Asberg, A:
Oslo Univ Hosp, Dept Transplantat Med, Oslo, Norway
Univ Oslo, Dept Pharm, Oslo, Norway
Moreso, F:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Barcelona Hosp Campus, Vall dHebron Res Inst VHIR,Kidney Transplant Unit,, Barcelona, Spain
Bestard, O:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Barcelona Hosp Campus, Vall dHebron Res Inst VHIR,Kidney Transplant Unit,, Barcelona, Spain
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