Transplantation · 1991 · 268 citations · 0 references
Organ DonationHeart FailureTransplantationKidney TransplantLongevityKidney TransplantationChronic Kidney DiseaseSolid Organ TransplantationOutcomes ResearchGraft SurvivalSurgeryOrgan AllocationLiver AllograftsLiver TransplantationMedicineDonor AgeNephrologyRepeat Transplant
The study analyzed donor age effects on outcomes using UNOS data for 12,131 kidney, 3,026 heart, and 2,913 liver allografts transplanted between 1987 and 1989. Kidney grafts from donors 6‑15 years old had a 7 % higher 1‑year survival than those from 56‑65, while donors >65 performed better than 56‑65 and ≤5 years were less satisfactory; heart grafts from 45‑55 donors had 8.4 % lower 1‑year survival than 16‑45 donors, and liver grafts from 16‑45 donors had 10.8 % better 1‑year survival than older donors, yet overall older donors can provide acceptable outcomes when organ function is normal and disease absent.
The influence of donor age on outcome was studied in the recipients of 12,131 cadaveric renal allografts, 3026 heart allografts, and 2913 liver allografts with followup information in the UNOS data base for transplants performed between 10/1/87 and 12/31/89. For recipients of kidney transplants, donors of ages 6-15 had significantly better 1-year graft survival than donors of ages 56-65, but the difference was only 7.0%. Donors of age greater than 65 actually did better than donors ages 56-65, but donors less than or equal to 5 were less satisfactory. Kidneys from older donors survived as well as kidneys from younger donors in patients with repeat transplants, diabetes, black race, age over 45, O HLA or 5 and 6 HLA matches, delayed graft function, shared kidneys and PRA greater than 50. For kidney recipients, multifactorial analysis by Cox regression showed that donor age was less important than the use of ALG, donor race, diabetes or peak PRA in ages 16-45, delayed function, repeat transplant, and HLA match. Recipients of heart transplants from donors ages 45-55 had 1-year graft survival that was 8.4% less than recipients of hearts from donors age 16-45. However, 32.7% of heart patients died during the first 12 months after listing without benefit of a transplant. Liver transplant recipients of donor ages 16-45 had 10.8% better 1-year graft survival than recipients of donors greater than 45, but a greater percentage of older donors were transplanted to high risk and older recipients. Tragically, 24.3% of patients listed for liver transplantation died within 12 months without a transplant. This analysis shows that satisfactory graft survival can be achieved using older donors and that age in itself should not be a barrier to organ donation, providing that organ function is normal and that specific disease of the organ is absent.