For older patients with end-stage renal disease (ESRD), the results of kidney transplants from "expanded criteria non-beating-heart" donors are not good, according to a paper presented at the American Society of Nephrology's 40th Annual Meeting and Scientific Exposition in San Francisco.
Led by Dr. Jagbir Gill of University of California Los Angeles, the researchers analyzed the outcomes of nearly 31,000 patients aged 60 or older who received deceased-donor kidney transplants in the United States between 1995 and 2006. Data for the study came from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS). The researchers compared the results of transplants from different types of donors:
- About 75 of kidneys came from standard criteria donors (SCD)—younger donors, without medical problems, who were brain-dead at the time of donation.
- Another 22 percent of kidneys came from expanded criteria donors (ECD). These donors have certain characteristics—such as older age, high blood pressure, or slightly decreased kidney function—that make them less than ideal as organ donors. However, because of the chronic shortage of organs for transplantation, ECD kidneys are an increasingly important alternative.
- The remaining three percent of kidneys came from non-beating-heart donors—sometimes called donation after cardiac death donors.
These are donors who are not yet brain-dead but have no chance of survival. The kidneys are removed for transplantation within minutes after the heart stops beating.
The chances of survival—both for the transplanted kidney and for the recipient—were best for patients receiving kidneys from brain-dead SCD (younger, healthier) donors. Survival rates were nearly as good for transplants using kidneys from non-beating-heart SCD donors.
However, the outcomes were not good for transplants using kidneys from non-beating-heart ECD (older, less healthy) donors. In this group, the risk of graft loss (failure of the transplanted kidney) was 65 percent higher than for patients who received kidneys from brain-dead ECD donors.
The risk of death was nearly twice as high for patients receiving kidneys from non-beating-heart, ECD donors. For this group, death appeared to be a more important risk than graft loss.
The study was designed specifically to evaluate the results of non-beating-heart kidney transplants in older adults. "Kidney transplants from non-beating-heart donors are believed to have equivalent outcomes compared to transplants from brain-dead donors," Dr. Gill explains. "Elderly patients with ESRD are a rapidly growing group of patients with unique characteristics, and it is important to assess outcomes in this patient population."
The results raise concerns about the transplantation of "non-beating-heart" kidneys in older adults with ESRD—particularly from ECD donors. The study suggests that, in patients aged 60 or older, kidneys from non-beating-heart SCD donors provide good results—outcomes are similar to kidneys from brain-dead SCD donors. However, the results are not good for kidneys from non-beating-heart ECD donors. These organs "should be used with caution in elderly recipients," Dr. Gill and colleagues conclude.
The study, "Kidney Transplantation in the Elderly Recipient Using Deceased Donor after Cardiac Death Organs: An Analysis of OPTN/UNOS Data,", was presented at Kidney Transplant Outcomes: Epidemiology, Clinical Trials and Health Services Research on Sunday, November 4 at 4:12 PM in Room 2005 of the Moscone Center.