Properly evaluated older donor kidneys work well

NEW YORK (Reuters Health) - Excellent long-term outcomes can be achieved using kidney transplants from donors older than 60 years of age, provided that the kidneys are properly evaluated prior to implantation, research shows.

In general, kidneys from older donors do not survive as long as those from younger donors, doctors point out in The New England Journal of Medicine this week. Selection of kidneys from older donors based on preimplantation characteristics might help narrow the gap in outcomes and expand the donor-organ pool, they add.

To investigate, Dr. Piero Ruggenenti, from the Mario Negri Institute for Pharmacological Research in Bergamo, Italy, and colleagues compared the outcomes of 62 patients given "histologically evaluated" kidneys from an older donor with those of 248 matched recipients given non-evaluated kidneys from either older or younger donors. All of the recipients were older than 50 years of age.

During a median follow-up of 23 months, the rate of progression to dialysis was 6 percent in the group given evaluated kidneys from older donors, 7 percent among those given kidneys from younger donors, and 23 percent among those given non-evaluated kidneys from older donors.

Using an evaluated graft from an older donor, rather than a non-evaluated one, cut the risk of graft failure more than threefold.

Preimplantation assessment of kidneys was associated with significantly better survival, in both the overall and older donor group analysis.

Dr. Francis L. Delmonico and Dr. James F. Burdick, the heads of major transplantation organizations in the US, comment in a related editorial: "This Italian group reports results that are relevant to increasing the rate of successful kidney transplantation anywhere in the world."

SOURCE: The New England Journal of Medicine, January 26, 2006.