A new study demonstrates the viability of kidney donation by elderly patients. After analyzing more than 2,500 patients on the waiting list, all over 60 years of age, mortality of those who received an organ from a donor over 80 years of age was significantly reduced, compared to those who remained on dialysis.
For patients with chronic renal failure, renal transplantation of very elderly donors is a better option than staying on dialysis treatment. This is demonstrated by a study of doctors from the Hospital del Mar and the Catalan Transplantation Organization (OCATT), who analyzed data of the Registry of Renal Patients of Catalonia —where all patients with advanced renal disease are registered in replacement therapy (dialysis or transplant). The work is published at the journal Transplantation.
The objective was to verify if a benefit in survival is provided by a kidney transplant from a donor of more than 80 years to a patient of more than 60, explains María José Pérez Sáez, deputy doctor of the Service of Nephrology of the Hospital del Mar.
The results show that this is the case. Even when compared to organs of donors of less than 80 years old (transplant survival is lower, 86% at 1 year and 64% at 5 years, compared to 93% and 83% of kidneys from younger donors), the receptor survival one year after transplantation is higher than in patients who continue dialysis treatment.
These data reinforce the commitment to this option, which in other countries is ruled out by the advanced age of donors. In this sense, Jaume Tort, director of l’OCATT, highlights “the importance of these studies to evaluate the quality and safety of practices related to organ transplantation; and, in this way, guarantee good results, especially for older patients on the waiting list.”
In total, the researchers analyzed data from 2,585 people over 60 years of age in renal replacement therapy included in the Registry of Renal Patients of Catalonia, in the waiting list for a kidney transplant between 1990 and 2014. Of these, 128 received a kidney from a donor over 80 years old.
This is the largest series of donors over 80 years old published in the scientific literature. The average follow-up was 4 years, up to a maximum of 21. Among the donors, the average age was over 82 years and almost two out of three were women. Among the recipients, the average age touched 72 years and there were more men than women.
More long-term benefits
The study has revealed that the risk of dying during the first month after transplantation is higher than continuing on dialysis. However, in the long term, this option offers a better survival, until reaching a clear benefit after 12 months of surgery.
This leads Pérez Sáez to emphasize that “a careful selection of the recipient is necessary, taking into account its functional status and comorbidities to avoid mortality and post-intervention complications to the maximum”. It must be taken into account that, in Catalonia, almost half of the new patients undergoing renal replacement therapy are over 70 years old, and that more than half of the renal donors exceed 60.
This work joins two previous studies from the same team of researchers who had analyzed the results of kidney transplants from elderly donors. All of them demonstrate the advantages for patients to undergo the intervention instead of continuing on dialysis.
Julio Pascual, director of the Medical and Assistance Area of the Parc de Salut Mar, head of the Nephrology Service and signatory of the study, points out that “this line of work, which brings together efforts of all transplant hospitals in Catalonia, consolidates the concept that we are confirming study after study: kidney transplantation from elderly donors is a better treatment option than dialysis for kidney patients.”