Korean J Transplant.  2023 Nov;37(Suppl 1):S172. 10.4285/ATW2023.F-7590.

Comparative analysis of kidney transplantation outcomes between extended criteria donors and waiting list in patients aged 60 and above

• Lee JJ
• Kwon H
• Kim YH
• Shin S
• Jung JH
• Ko Y

• KMID: 2551792
• DOI: http://doi.org/10.4285/ATW2023.F-7590

Abstract

Background
The decision to perform kidney transplantation with extended criteria donor (ECD) kidneys in elderly patients remains a topic of ongoing debate. This study aims to evaluate whether receiving an ECD kidney provides a survival benefit in patients aged 60 and above compared to remaining on the waiting list.
Methods
A retrospective analysis was conducted on 178 patients aged 60 and above who received deceased donor kidney transplants and 909 patients on the waiting list from January 2008 to February 2023 at a single center. Transplant recipients were stratified based on the presence or absence of heart or cerebrovascular diseases.
Results
Multivariate analysis identified age (hazard ratio [HR], 1.162; 95% confidence interval [CI], 1.061–1.273), arrhythmias (HR, 4.047; 95% CI, 1.432–11.436), and history of cerebrovascular accidents (HR, 2.912; 95% CI, 1.174–7.223) as significant predictors of reduced survival. In contrast, factors such as ECD status, kidney donor profile index, and dialysis duration were not significant. The Kaplan-Meier survival analysis revealed that transplant recipients without these comorbidities had comparable survival rates to those on the waiting list, while those with comorbidities had significantly lower survival (P<0.001).
Conclusions
This study suggests that, in patients aged 60 and above, heart or cerebrovascular diseases are a more significant determinant of survival rates than receiving an ECD kidney. Therefore, a comprehensive pretransplant assessment for these comorbidities is crucial in this patient population.