Increasing numbers of elderly (≥65 years) patients are listed for kidney transplantation. This study compares the survival outcome between living (LDK), regularly allocated (ETKAS) and Eurotransplant Senior Program (ESP) donor kidneys in elderly recipients.
This is a single-center retrospective cohort study of elderly kidney transplant recipients transplanted between 2005 and 2017. Primary outcome measures were non-death-censored graft, death-censored graft and patient survival.
In total 348 patients were transplanted, 109 recipients (31.3%) received an LDK, 100 (28.7%) an ETKAS,139 (40%) an ESP kidney. 62.5% were male, median age was 68 years. LDK recipients had significantly better 5-year non-death-censored graft survival compared to ETKAS and ESP (resp. 71.0% vs. 66.1% vs. 55.6%, p=0.047). Death-censored graft survival after 1 year was significantly better in LDK recipients (99.1%) (ETKAS 90.8%; ESP 87.7%, p<0.001). After 5 years, the difference remained significant (p<0.001) with little additional graft loss (97.7% vs. 88.1% vs. 85.6). There was no significant difference in patient survival after 5 years (71.7% vs. 67.4% vs 61.9%, p=0.480).
In elderly recipients the patient survival benefits of an LDK are limited, but there is decreased death-censored graft loss for LDK recipients. Nevertheless, graft survival in ETKAS and ESP remains satisfactory.

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