CADAVER DONORS GREATER THAN AGE 55: WHICH KIDNEYS TO USE?

Abstract

331 Many studies have demonstrated a significant detriment to long-term graft function with the use of older cadaver kidneys; yet the growing organ shortage has led to a steady increase in the use of older donors. The aim of our study was to evaluate the prognosis and outcome with older cadaver kidneys and to determine donor specific risk factors for poor outcome. Between 01/01/84 and 06/30/97, we did 709 primary cadaver kidney transplants: 107 with cadaver donors >55 years, and 602 with donors 18 to 55 years. The mean donor age in the group >55 was 61.2; in the group 18 to 55, 33.8 years (p=.001). Kidneys from older donors tended to be transplanted into older recipients (p=0.03). Graft survival was significantly worse with donors >55, but only in the subgroup of donors who died of cardiovascular or cerebrovascular causes. Recipients with donors >55 had a higher incidence of acute rejection (p=0.006), chronic rejection (p=0.001), and delayed graft function (p=0.001). By mutivariate analysis, cause of donor death was the most significant donor variable for poor outcome. Elevated donor creatinine (Cr) and prolonged kidney preservation time also tended toward increased risk. (Tables)TableTableConclusion: Older cadaver kidneys are now used more frequently, but they are associated with an increased incidence of delayed graft function and acute rejection and with decreased long-term graft survival. In our study, cerebrovascular or cardiovascular causes of donor death, elevated donor Cr, and prolonged kidney preservation time were associated with poor outcome. Knowing the risk factors may help decide which older cadaver kidneys to use.