Eurotransplant Senior Program Research Articles

La transplantation d’organes chez le sujet âgé

The aging of organ donor and recipient populations is raising new issues in kidney transplantation. Transplantation is generally considered the best treatment for end-stage renal disease (ESRD), but this remains to be demonstrated in elderly populations (> 65 years). The main issues can be summarized as follows: the population of geriatric patients with ESRD is expanding rapidly, and more data are needed to determine whether transplantation confers a survival advantage, as in younger populations; the critical shortage of cadaveric donors is leading to the use of older kidneys, which may not last as long; and increasing numbers of older individuals wish to donate a kidney to a relative, and particularly to their spouse. Several specific programs have been launched, including the Eurotransplant Senior program, the Old for Old program and the Two Marginal Kidneys for One Recipient program. Further research is needed to evaluate the efficacy and safety of these new applications. Nephrologists and urologists caring for elderly populations with ESRD need specific geriatric training.

Outcomes of Transplanting Deceased-Donor Kidneys between Elderly Donors and Recipients

Rate of acceptance of deceased-donor kidneys decreases with donor age despite the growing number of aged transplant candidates on the waiting list. In the Eurotransplant Senior Program, HLA-unmatched kidneys from deceased donors aged > or = 65 yr are transplanted regionally into recipients aged > or = 65 yr. Because we have become more willing to accept kidneys from donors aged > or = 75 yr than previous years, we performed a retrospective analysis of this subgroup. Kidneys were accepted from donors aged > or = 75 yr provided a normal creatinine on admission to the hospital, a Cockcroft-Gault creatinine clearance > 80 ml/min, and an absence of comorbidities. We compared outcomes of kidneys from donors aged > or = 75 yr with both younger-donor kidneys transplanted in the Eurotransplant Senior Program and with younger-donor HLA-matched kidneys transplanted into recipients > or = 60 yr. There were no differences in 5-yr graft and patient survival or rate of delayed graft function between groups. Graft function, measured by creatinine and creatinine clearance, differed without pattern at only three of 12 time points during 5 yr of follow-up. In conclusion, our data suggest that kidneys from deceased donors aged > or = 75 yr can be transplanted safely into recipients aged > or = 65 yr if similar donor criteria and local allocation practices are used.

An old virtue to improve senior programs

Over the past decades, there have been significant demographic changes in patients awaiting deceased donor kidney transplants, with the largest increases in the > or = 65 year-age group. Because most allograft failures in older recipients are the result of death with a functioning graft, the transplant community has adopted the position that older donor kidneys, with reduced half-lives, often can provide suitable, lifelong function for an elderly recipient. Since 1999, the Eurotransplant Senior Program (ESP) allocates kidneys from donors > or = 65 years, without prospective matching for HLA antigens, to local transplant candidates > or = 65 years. The rationale behind this policy was to expedite the change of the elderly to receive a transplant and to reduce cold ischemia time to prevent ischemic injury and hereby delayed graft function and the increased risk of rejection. Two issues have been identified with the use of old donor kidneys. First, there is an increased incidence of acute interstitial rejection, compared with kidneys from younger donors and secondly, once a rejection episode occurs, the ability to mount a tissue repair process seems impaired. Especially in the elderly, avoiding acute rejection must be balanced against the greater risk of excessive immunosuppression, putting these recipients at higher risk of infection and malignancy. Combined matching for age as well as HLA-DR antigens may further improve the results of Senior Programs.

Prospective Age-Matching in Elderly Kidney Transplant Recipients—A 5-Year Analysis of the Eurotransplant Senior Program

Renal transplantation faces challenges: the organ shortage resulting in extended waiting times and an aging population resulting in death with a functioning graft. The Eurotransplant Senior Program (ESP) allocates kidneys within a narrow geographic area from donors aged >/=65 years to recipients >/=65 years regardless of HLA. This analysis investigates the impact of the ESP on waiting time, graft and patient survival. The ESP group (n = 1406, old to old) was compared to two groups allocated via the Eurotransplant Kidney Allocation System (ETKAS) with either similar donor age (old to any [O/A], donor age >/=65, n = 446) or recipient age (any to old, [A/O], recipient age 60-64, n = 1687). All patients were transplanted between 1999 and 2004. Since initiation of the ESP (1999), availability of elderly donors doubled and waiting time for ESP patients decreased. Local allocation led to shorter cold ischemia time (11.9 vs. >17.0 h, p < 0.001) and less delayed graft function (DGF, ESP 29.7% vs. O/A 36.2%, p = 0.047) but 5-10% higher rejection rates. Graft and patient survival were not negatively affected by the ESP allocation when compared to the standard allocation. The ESP age matching of elderly donors and recipients is an effective allocation system for organs from elderly donors.

The advantage of allocating kidneys from old cadaveric donors to old recipients: a single‐center experience

In January 1999 a new kidney allocation program was launched by the Eurotransplant Foundation, the 'Eurotransplant Senior Program' (ESP). Cadaveric donors above the age of 65 yr are allocated to kidney transplant recipients of the same age group. Using a single-center database, 91 patients who underwent first renal transplantation at the age of 65 yr and older in the years 1999-2002 were identified. Fifty-six patients were transplanted through ESP allocation (study group) and 35 patients (control group) via normal Eurotransplant Kidney Allocation System (ETKAS) procedure. Age, sex and comorbid conditions did not differ by group. The rate of acute rejection episodes, primary non-function, delayed graft function, perioperative mortality did not differ by group. Serum creatinine was significantly lower in the ETKAS group (1.3 vs. 1.9 mg/dL; p=0.015) from six months after the transplantation on. Overall graft survival at six yr was 56% in the ETKAS group and 52% in the ESP group. With 73% in the ETKAS group and 71% in the ESP group, cumulative patient survival according to the Kaplan-Meier estimation was not statistically different at five yr. We did not find a relevant difference in the outcome between young and old kidney transplants in old recipients after this long observation period.

Long-Term Patient and Graft Survival in the Eurotransplant Senior Program: A Single-Center Experience

BACKGROUND The Eurotransplant Senior Program (ESP) was launched in 1999, targeted to increase the supply of donor kidneys to the elderly. This program requires local allocation of kidneys from cadaveric donors >>65 years to recipients >>65 years. METHODS Of all patients >>65 years who received a kidney transplant in 1999-2002 at our center, 59 patients were transplanted through the ESP protocol (ESP group), and 44 patients received a transplant from a younger donor (EuroTransplant Kidney Allocation System, ETKAS group). Recipients were followed for up to 5.3 years using the Austrian Dialysis and Transplant Registry. Outcomes studied included all-cause mortality and allograft loss. RESULTS Age, sex, and comorbid conditions did not differ by group. Donor age was higher (69 vs. 36 years; P < 0.001) and cold ischemia time shorter in the ESP group (10 vs. 15 hr; P < 0.001). Number of HLA mismatches was greater in the ESP group (3.8 vs. 3.0; P = 0.003). ESP patients were more likely to receive induction therapy and less likely to receive cyclosporine A. Primary nonfunction, delayed graft function, operative mortality, rate of acute rejection episodes, and length of stay did not differ by group. Although serum creatinine at discharge was higher in ESP patients (1.7 vs. 1.4 mg/dL; P < 0.001), 4-year mortality (hazard ratio [HR] = 0.68; 95% CI: 0.31-1.49) and graft loss (HR = 0.61; 95% CI: 0.29-1.28) tended to be less. CONCLUSIONS Long-term patient and graft survival were comparable between elderly patients who received their organ via the ESP and the regular ETKAS algorithm.

1459: Expanding the Donor Pool in Kidney Transplantation - 7 Years Experience with Eurotransplant Senior Program

You have accessJournal of UrologyPodium, Wednesday, May 24, 2006, 8:00 - 10:00 am1 Apr 20061459: Expanding the Donor Pool in Kidney Transplantation - 7 Years Experience with Eurotransplant Senior Program Markus Giessing, Florian T. Fuller, Max Tuellmann, Lutz Liefeldt, Klemens Budde, and Stefan A. Loening Markus GiessingMarkus Giessing More articles by this author , Florian T. FullerFlorian T. Fuller More articles by this author , Max TuellmannMax Tuellmann More articles by this author , Lutz LiefeldtLutz Liefeldt More articles by this author , Klemens BuddeKlemens Budde More articles by this author , and Stefan A. LoeningStefan A. Loening More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33663-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1459: Expanding the Donor Pool in Kidney Transplantation - 7 Years Experience with Eurotransplant Senior Program." The Journal of Urology, 175(4S), p. 471 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 471 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Markus Giessing More articles by this author Florian T. Fuller More articles by this author Max Tuellmann More articles by this author Lutz Liefeldt More articles by this author Klemens Budde More articles by this author Stefan A. Loening More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-Term Patient and Graft Survival in the Eurotransplant Senior Program: A Single-Center Experience

The Eurotransplant Senior Program (ESP) was launched in 1999, targeted to increase the supply of donor kidneys to the elderly. This program requires local allocation of kidneys from cadaveric donors >>65 years to recipients >>65 years. Of all patients >>65 years who received a kidney transplant in 1999-2002 at our center, 59 patients were transplanted through the ESP protocol (ESP group), and 44 patients received a transplant from a younger donor (EuroTransplant Kidney Allocation System, ETKAS group). Recipients were followed for up to 5.3 years using the Austrian Dialysis and Transplant Registry. Outcomes studied included all-cause mortality and allograft loss. Age, sex, and comorbid conditions did not differ by group. Donor age was higher (69 vs. 36 years; P < 0.001) and cold ischemia time shorter in the ESP group (10 vs. 15 hr; P < 0.001). Number of HLA mismatches was greater in the ESP group (3.8 vs. 3.0; P = 0.003). ESP patients were more likely to receive induction therapy and less likely to receive cyclosporine A. Primary nonfunction, delayed graft function, operative mortality, rate of acute rejection episodes, and length of stay did not differ by group. Although serum creatinine at discharge was higher in ESP patients (1.7 vs. 1.4 mg/dL; P < 0.001), 4-year mortality (hazard ratio [HR] = 0.68; 95% CI: 0.31-1.49) and graft loss (HR = 0.61; 95% CI: 0.29-1.28) tended to be less. Long-term patient and graft survival were comparable between elderly patients who received their organ via the ESP and the regular ETKAS algorithm.

Long-Term Patient and Graft Survival in the Eurotransplant Senior Program: A Single-Center Experience

Long-Term Patient and Graft Survival in the Eurotransplant Senior Program: A Single-Center Experience

INCREASING THE KIDNEY DONOR POOL BY MORE EFFICIENT USE OF KIDNEYS RECOVERED FROM DECEASED DONORS.

P22 Background: Despite the continuing shortage of kidneys from deceased organ donors, many kidneys that are recovered in the US are not transplanted. Methods: We compared the rate of kidney procurement and transplantation between January 2000 and June 2003 in the US and in the Eurotransplant (ET) region (Austria, Belgium, Germany, Luxemburg, the Netherlands, Slovenia), for different donor age groups. Results: In the US, 38,275 kidneys were recovered for transplantation between 2000-2003 and 32,809 (85.7%) were transplanted. During the same period, 11,630 kidneys were recovered in the ET region and 11,033 (94,9%) were transplanted. The discard rates according to donor age shown in the figure reveal that the US discards 37% of kidneys from donors aged 61-65 and 54% of kidneys from donors over age 65 that were recovered for transplantation, whereas ET discards 7% and 8% of kidneys from these age groups, respectively. “Biopsy findings” was the most commonly cited reason for discarding older kidneys (44% of discards) in the US. Only 30% of kidneys from donors aver age 65 were transplanted to recipients over age 65 in the US compared with more than two-thirds in ET. The over age 65 donor accounted for 6% of kidneys procured in the US and 11% of those procured in ET.FigureConclusions: The US discards more than 1,500 deceased donor kidneys each year that were recovered for transplantation but subsequently judged to be unsuitable. Eurotransplant makes better use of the older donor kidneys probably by encouraging participation in the Eurotransplant Senior Program, in which over age 65 donor kidneys are preferentially allocated to over age 65 recipients. (Am J Transpl. 2002; 2: 664-670.)

It takes six to boogie: allocating cadaver kidneys in Eurotransplant.

In March 1996, a new allocation point system for cadaver kidneys, the Eurotransplant (ET) Kidney Allocation System (KAS), was introduced in ET, the first multinational organ exchange organization. The aims of ETKAS were to reduce average and maximum waiting time, to allow patients with rare human leukocyte antigen (HLA) phenotypes or combinations to receive an "optimal" offer, to keep the exchange rates between the participating countries balanced, and finally to keep optimal graft survival, by means of HLA matching. Elderly patients and highly sensitized patients profit in addition from special programs, the ET Senior Program and the Acceptable Mismatch Program, respectively. All kidneys are offered to the pool and are allocated according to the degree of HLA matching, mismatch probability, waiting time, distance from the donor center, and balance between the countries participating in ET. A summary of 6 years' experience with the ETKAS is presented in this article.

"Old-for-old" cadaveric renal transplantation: surgical findings, perioperative complications and outcome.

To evaluate the surgical findings and outcome of locally allocated, blood-group-compatible but HLA-unmatched cadaveric kidneys in first renal transplantation of donor/recipient pairs aged 65 years and above (Eurotransplant Senior Program=ESP). 26 patients of the study group (donor age 70.4 +/- 3.6/recipient age 67.7 +/- 2.8) were compared to 30 controls aged 60 and above (mean recipient age 62.6 +/- 2.3/mean donor age 43.8 +/- 15.3). For controls kidney allocation included HLA matching. Cold ischemic time (ESP vs. controls 501 vs. 883 min; p<0.05) and mean number of HLA mismatches (4.2 +/- 1.36 vs. 1.6 +/- 1.62; p<0.05) differed significantly. Delayed graft function was lower in the study group (12% vs. 43%; p<0.05), rejection episodes in the ESP group were numerous but did not differ significantly from the controls (46% vs. 30%; p=0.21). More intraoperative complications and a higher incidence of donor organ arteriosclerosis (p<0.05) were seen in the ESP group. Three-year graft survival uncensored and censored for death with functioning graft did not differ, even though mean creatinine and creatinine clearance differed significantly beginning at month three. Three-year patient survival (55% vs. 81%) differed in favour of the control group, even though the difference was not significant due to small number of patients. "Old-for-old" kidney transplantation with local allocation yields graft survival rates comparable to HLA-matched young grafts and is a good approach to extend the donor and recipient pool. Careful patient selection is advised.

Evaluation of the Eurotransplant Senior Program. The Results of the First Year

On 4 January 1999, the Eurotransplant Senior Program (ESP) was implemented within the Eurotransplant kidney allocation scheme. Kidneys obtained from donors aged over 65 years of age (65+) were allocated to a selected group of nonimmunized 65+ patients undergoing their first transplant. All transplants were performed locally to minimize cold-ischemic time. All transplants performed with kidneys from elderly donors that were allocated via ESP (ESP group) were compared to transplants performed with similar kidneys allocated via the standard renal allocation system (control group). Initial kidney function and 1-year graft outcome were assessed. In 1999, 227 ESP and 102 control transplants were performed. The duration of cold-ischemic time was 12 and 19 h for the ESP and control groups, respectively. No rejection episodes occurred in 60% and 67% of the ESP patients and controls, respectively, while a direct kidney function was observed in 59% of ESP and 49% of control patients. The 1-year graft survival rates, censoring for graft losses due to deaths in patients with functioning grafts, were 86% and 79%, respectively. An old-for-old renal allocation algorithm can be successful provided that risk factors, such as cold-ischemic time, are reduced.

Kidney transplantation in the elderly

As the number of both elderly patients suffering from end-stage renal disease and of elderly donors is increasing, Eurotransplant has started the Eurotransplant Senior Program (ESP). New strategies for treatment of patients who need dialysis and improved screening methods allow renal transplantation even in elderly patients. Improved immunosuppressive protocols for older recipients lead to higher patient survival rates and improved quality of life.

Eurotransplant Senior Program 'old for old': results from 10 patients.

More frequently there is the need for renal transplantation of older patients. Against the background of an increasing number of old donors and recipients, Eurotransplant Leiden started the Eurotransplant Senior Program (ESP) 'old for old' in 1999. The ESP works with donors and recipients both over 65 yr. The kidneys are transplanted with short cold ischaemia time regardless of the human leukocyte antigen (HLA) compatibility. Compatibility of blood groups, negative crossmatch and less than 5% cytotoxic antibodies are required. First experiences from 10 patients at Heinrich Heine University hospital are reported here. The course of 10 transplanted patients is described from January 1999 until November 1999 (28.4+/-15.8 wk). Age of donor and recipient, cause of dialysis and concomitant diseases from recipients, function of the transplanted kidney and complications are analysed. Immunosuppression consisted initially of cyclosporin A, mycophenolic acid and steroids. The results of these 10 patients were compared to 14 patients who were transplanted according to the ordinary Eurotransplant criteria (Eurotransplant Kidney Allocation System) in the same period of time. Kidneys from six donors (70.5+/-3.3 yr) were transplanted to 10 different recipients (66.9+/-2.2 yr). The control group consisted of 14 patients (47.6+/-14.4 yr) who received kidneys from 14 donors (48.3+/-10.1 yr). One double kidney transplantation was performed in the senior group, i.e. two kidneys from a marginal donor were transplanted to one recipient ('two in one'). In the ESP group, cold ischaemia time was reduced by 5 h and mean of HLA mismatches was more than doubled. Mean length of hospitalisation of ESP and control groups was 47.2+/-28.2 and 34.2+/-11.6 d, respectively. Intraoperatively, no complications were seen, post-operative care was performed on a normal ward. ESP patients suffered more often from delayed graft function, which led to further need for haemodialysis for 11.2 d. Finally, 9 of 10 patients acquired a satisfactory renal graft function. A total of 13 biopsies were performed in eight cases. Altogether seven acute rejections in 6 patients were found (four interstitial, one vascular, one interstitial+vascular, one clinical). The 9 patients with sufficient renal graft function were discharged with a mean serum creatinine level of 2.3+/-0.5 mg/dL (control: 1.9+/-0.8 mg/dL). Comparing these 10 recipients to a control group consisting of 14 patients, the results are comparable and encouraging. In conclusion, the short-term results of the ESP are promising. Nevertheless, the post-operative care requires more attention due to several complications. Though the HLA compatibility was not considered, all rejections were coped with effectively. Quality of life was improved.