Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates

A. O. Ojo, J. A. Hanson, H. U. Meier-Kriesche, C. N. Okechukwu, R. A. Wolfe, A. B. Leichtman, L. Y. Agodoa, B. Kaplan, F. K. Port

Research output: Contribution to journalArticle

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Abstract

An increasing number of cadaveric kidney transplants are now performed with organs from donors who would have been deemed unsuitable in earlier times. Although good allograft outcomes have been obtained with these marginal donor transplants, it is unclear whether recipients of marginal kidney transplants achieve a reduction in long-term mortality as do recipients of "ideal" kidneys. Patients with end-stage renal disease registered on the cadaveric renal transplant waiting list between January 1, 1992, and June 30, 1997, were studied for mortality risks according to three outcomes: wait-listed on dialysis treatment with no transplant (WLD); transplantation with marginal donor kidney (MDK); and "ideal" or optimal donor kidney transplantation (IDK). Thirty-four percent of wait-list registrants had received a cadaveric kidney transplant by June 30, 1998. Of these, 18% received a marginal kidney that had one or more of the following pretransplant factors: donor age >55 yr, non-heartbeating donor, cold ischemia time >36 h, and donor hypertension or diabetes mellitus of >10 yr duration. Five-year graft and patient survival was 53% and 74% for MDK recipients compared with 67% (P <0.001) and 80% (P <0.001) for IDK recipients. Adjusted annual death rate and estimated remaining life time was 6.3%, 4.7%, and 3.3% and 15.3 yr, 20.4 yr, and 28.7 yr for WLD, MDK, and IDK groups, respectively. The average increase in life expectancy for MDK recipients compared with the WLD cohort was 5 yr, although this benefit varied from 3 to 10 yr depending on the recipient's characteristics. It is concluded that transplantation of a marginal kidney is associated with a significant survival benefit when compared with maintenance dialysis.

Original languageEnglish (US)
Pages (from-to)589-597
Number of pages9
JournalJournal of the American Society of Nephrology
Volume12
Issue number3
StatePublished - 2001
Externally publishedYes

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Tissue Donors
Transplants
Kidney
Survival
Mortality
Dialysis
Transplantation
Cold Ischemia
Waiting Lists
Age Factors
Graft Survival
Life Expectancy
Kidney Transplantation
Chronic Kidney Failure
Allografts
Diabetes Mellitus
Maintenance
Hypertension

ASJC Scopus subject areas

  • Nephrology

Cite this

Ojo, A. O., Hanson, J. A., Meier-Kriesche, H. U., Okechukwu, C. N., Wolfe, R. A., Leichtman, A. B., ... Port, F. K. (2001). Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. Journal of the American Society of Nephrology, 12(3), 589-597.

Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. / Ojo, A. O.; Hanson, J. A.; Meier-Kriesche, H. U.; Okechukwu, C. N.; Wolfe, R. A.; Leichtman, A. B.; Agodoa, L. Y.; Kaplan, B.; Port, F. K.

In: Journal of the American Society of Nephrology, Vol. 12, No. 3, 2001, p. 589-597.

Research output: Contribution to journalArticle

Ojo, AO, Hanson, JA, Meier-Kriesche, HU, Okechukwu, CN, Wolfe, RA, Leichtman, AB, Agodoa, LY, Kaplan, B & Port, FK 2001, 'Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates', Journal of the American Society of Nephrology, vol. 12, no. 3, pp. 589-597.
Ojo, A. O. ; Hanson, J. A. ; Meier-Kriesche, H. U. ; Okechukwu, C. N. ; Wolfe, R. A. ; Leichtman, A. B. ; Agodoa, L. Y. ; Kaplan, B. ; Port, F. K. / Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. In: Journal of the American Society of Nephrology. 2001 ; Vol. 12, No. 3. pp. 589-597.
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AU - Hanson, J. A.

AU - Meier-Kriesche, H. U.

AU - Okechukwu, C. N.

AU - Wolfe, R. A.

AU - Leichtman, A. B.

AU - Agodoa, L. Y.

AU - Kaplan, B.

AU - Port, F. K.

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N2 - An increasing number of cadaveric kidney transplants are now performed with organs from donors who would have been deemed unsuitable in earlier times. Although good allograft outcomes have been obtained with these marginal donor transplants, it is unclear whether recipients of marginal kidney transplants achieve a reduction in long-term mortality as do recipients of "ideal" kidneys. Patients with end-stage renal disease registered on the cadaveric renal transplant waiting list between January 1, 1992, and June 30, 1997, were studied for mortality risks according to three outcomes: wait-listed on dialysis treatment with no transplant (WLD); transplantation with marginal donor kidney (MDK); and "ideal" or optimal donor kidney transplantation (IDK). Thirty-four percent of wait-list registrants had received a cadaveric kidney transplant by June 30, 1998. Of these, 18% received a marginal kidney that had one or more of the following pretransplant factors: donor age >55 yr, non-heartbeating donor, cold ischemia time >36 h, and donor hypertension or diabetes mellitus of >10 yr duration. Five-year graft and patient survival was 53% and 74% for MDK recipients compared with 67% (P <0.001) and 80% (P <0.001) for IDK recipients. Adjusted annual death rate and estimated remaining life time was 6.3%, 4.7%, and 3.3% and 15.3 yr, 20.4 yr, and 28.7 yr for WLD, MDK, and IDK groups, respectively. The average increase in life expectancy for MDK recipients compared with the WLD cohort was 5 yr, although this benefit varied from 3 to 10 yr depending on the recipient's characteristics. It is concluded that transplantation of a marginal kidney is associated with a significant survival benefit when compared with maintenance dialysis.

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