Kidney transplantation outcomes from expanded criteria donors, standard criteria donors or living donors older than 60 years

Figures & data

Figure 1. Study design.

Table 1. Description of the kidney transplant cohort and the donor pool.

Characteristics of recipients, N = 568	Frequency N (%) or mean(±SD)
Age (years), N = 559	45.4 (±14.08)
Gender (Male), N = 568	366 (64.4%)
Pre-transplant hemodialysis time (months),  N = 543	53.4 (±41.7)
HLA mismatches, N = 559	3.1 (±1.2)
Cold ischemia time (hours), N = 244	19.5 (±6.2)
Panel reactive antibody >30%, N = 549	96 (17.5%)
Panel reactive antibody >70%, N = 549	42 (7.7%)
Delayed graft function (DGF), N = 554	203 (36.6%)
Hemodialysis sessions, N = 200	5.7 (3.85)
Immunosuppression – induction
Monoclonal antibodies (basiliximab or  daclizumab)	100%
Immunosuppression – maintenance
Calcineurin Inhibitor (CNI), N = 512	508 (99.2%)
Mycophenolic Acid (MPA), N = 512	428 (83.6%)
mTOR, N = 512	78 (15.2%)
Corticosteroids, N = 511	511 (100%)
CNI + MPA + Steroids, N = 512	424 (82.8%)
CNI + mTOR + Steroids, N = 512	75 (14.6%)
MPA + mTOR + Steroids, N = 512	3 (0.5%)
Patients with acute rejection episode (ARE), N = 504	45 (10.3%)
Absolute number of ARE, N = 504	48
Incidence rate of ARE (per patient per year), N = 504	0.03
Follow-up time (months), N = 560	39.14 (±24.6)
Characteristics of the donor pool
Donor source, N = 565
Living donor	231 (40.9%)
Deceased donor	334 (59.1%)
Age (years), N = 557	52.9 (±15.7)
Gender (male), N = 568	366 (64.4%)
History of hypertension (HTN), N = 520	141 (27.1%)
History of diabetes mellitus (DM), N = 521	23 (4.4%)
Cerebrovascular event as cause of death (CVE), N = 326	185 (56.7%)
Pre-retrieval serum creatinine >1.5 mg/dL, N = 533	146 (27.4%)
Deceased donor, N = 334
Expanded criteria donor (ECD), N = 331	142 (42.5%)
Non-expanded criteria donor (SCD), N = 331	192 (57.5%)
Living donor, N = 231
Living donor (LD) >60 yrs, N = 225	96 (42.7%)

Table 2. Comparison of characteristics and outcomes between the ECD and SCD groups (all deceased donors).

Characteristic, Mean ± SD	ECD N = 142	SCD N = 192	p Value
Recipient age (years)	51.7 ± 11.9	50.0 ± 13.1	0.230
Recipient gender (F/M)	58/84	72/120	0.530
Pre-transplant dialysis time (months)	75.6 ± 34.8	78.3 ± 36.7	0.512
HLA mismatches	3.1 ± 1.095	3.07 ± 1.2	0.945
Cold ischemia time (hours)	19.6 ± 7.03	19.5 ± 5.6	0.904
Panel reactive antibody > 30%	37/139	43/187	0.452
Panel reactive antibody > 70%	19/139	15/187	0.099
Delayed graft function	87/140	96/187	0.051
Sessions of dialysis	6.2 ± 4.1	5.6 ± 3.8	0.293
Serum creatinine at first year (mg/dL)	1.65 ± 0.75	1.2 ± 0.4	<0.001
eGFR at first year (mL/min)	49.9 ± 17.3	64.6 ± 18.7	<0.001
Serum creatinine at end of follow-up (mg/dL)	2.1 ± 1.9	1.3 ± 0.9	<0.001
eGFR at end of follow-up (mL/min)	49.5 ± 22.3	68.0 ± 24.4	<0.001
Incidence rate of ARE (per patient per year)	0.05	0.01	0.013
Follow-up time (months)	36.4 ± 24.6	41.2 ± 24.8	0.08

Table 3. Comparison of outcomes between the ECD and LD >60 years groups.

Characteristic	ECD N = 142	LD > 60 yrs N = 96	p Value
Recipient age (years)	51.7 ± 11.865	41.9 ± 10.8	<0.001
Recipient gender (F/M)	58/84	33/63	0.314
Pre-transplant dialysis time (months)	75.6 ± 34.8	18.9 ± 21.35	<0.001
HLA mismatches	3.1 ± 1.095	2.3 ± 0.9	<0.001
Panel reactive antibody > 30%	37/139	9/94	0.001
Panel reactive antibody > 70%	19/139	6/94	0.078
Delayed graft function	87/140	12/94	<0.001
Sessions of dialysis	6.2 ± 4.1	5.5 ± 2.2	0.597
Serum creatinine at first year (mg/dL)	1.65 ± 0.75	1.6 ± 0.45	0.537
eGFR at first year (mL/min)	49.9 ± 17.3	51.765 ± 15.85	0.470
Serum creatinine at end of follow-up (mg/dL)	2.1 ± 1.9	1.61 ± 0.5	0.008
eGFR at end of follow-up (mL/min)	49.5 ± 22.3	49.8 ± 16.15	0.907
Patients with at least one ARE, N(%)	16	11
Incidence rate of ARE (per patient per year)	0.05	0.05	0.521
Follow-up time (months)	36.4 ± 24.6	40.0 ± 23.9	0.267

Figure 2. Cumulative graft survival for the ECD and SCD (non-ECD) groups.

Figure 3. Cumulative graft survival for the ECD and LD >60 years groups.

Figure 4. Cumulative graft survival for the ECD >70 years and SCD (non-ECD) groups.

Table 4. Comparison of characteristics and outcomes between the ECD >70 years and SCD groups (all deceased donors).

Characteristic, Mean ± SD	ECD > 70 yrs N = 30	SCD N = 192	p Value
Recipient age (years)	59.1 ± 9.7	50.04 ± 13.1	<0.001
Recipient gender (F/M)	11/19	72/120	0.931
Pre-transplant dialysis time (months)	73.0 ± 27.2	78.3 ± 36.7	0.454
HLA mismatches	3.4 ± 1.1	3.07 ± 1.2	0.116
Cold ischemia time (hours)	19.3 ± 5.3	19.5 ± 5.6	0.873
Panel reactive antibody > 30%	6/29	43/187	0.783
Panel reactive antibody > 70%	3/29	15/187	0.716
Delayed graft function	22/30	96/187	0.025
Sessions of dialysis	6.2 ± 4.6	5.6 ± 3.8	0.523
Serum creatinine at first year (mg/dL)	1.7 ± 0.75	1.2 ± 0.4	0.004
eGFR at first year (mL/min)	47.5 ± 16.7	64.6 ± 18.7	<0.001
Serum creatinine at end of follow-up (mg/dL)	2.3 ± 2.2	1.3 ± 0.9	0.031
eGFR at end of follow-up (mL/min)	46.25 ± 21.7	67.96 ± 24.4	<0.001
Patients with at least one ARE, N (%)	6	7
Incidence rate of ARE (per patient per year)	0.08	0.01	0.01
Follow-up time (months)	41.4 ± 23.04	41.2 ± 24.8	0.970

Table 5. Comparison of characteristics and outcomes between the ECD >70 years and LD > 60 years groups.

Characteristic	ECD > 70 yrs N = 30	LD > 60 yrs N = 96	p Value
Recipient age (years)	59.1 ± 9.7	41.9 ± 10.8	<0.001
Recipient gender (F/M)	11/19	33/63	0.818
Cause of ESRD
Pre-transplant dialysis time (months)	73.0 ± 27.2	18.9 ± 21.35	<0.001
HLA mismatches	3.4 ± 1.1	2.3 ± 0.91	<0.001
Panel reactive antibody > 30%	6/29	9/94	0.110
Panel reactive antibody > 70%	3/29	6/94	0.474
Delayed graft function	22/30	12/94	<0.001
Sessions of dialysis	6.2 ± 4.6	5.5 ± 2.2	0.597
Serum creatinine at first year (mg/dL)	1.72 ± 0.76	1.59 ± 0.45	0.338
eGFR at first year (mL/min)	47.48 ± 16.7	51.77 ± 15.85	0.260
Serum creatinine at end of follow-up (mg/dL)	2.3 ± 2.2	1.6 ± 0.5	0.130
eGFR at end of follow-up (mL/min)	46.25 ± 21.70	49.8 ± 16.15	0.369
Patients with at least one ARE, N(%)	6	11
Incidence rate of ARE (per patient per year)	0.08	0.05	0.456
Follow-up time (months)	41.4 ± 23.04	39.99 ± 23.9	0.774