EVALUATION OF THE OLDER CADAVERIC KIDNEY DONOR: THE IMPACT OF DONOR HYPERTENSION AND CREATININE CLEARANCE ON GRAFT PERFORMANCE AND SURVIVAL12

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Abstract
The use of older donors for cadaveric renal transplantation (CRT) remains controversial because older donors are associated with decreased graft survival, yet offer the opportunity for donor pool expansion.We investigated the impact of two age-related donor factors, hypertension and calculated creatinine clearance (C Cr), as predictors of graft outcome in recipients of CRTs from donors ≥55 years of age. We reviewed 33,595 recipients of CRTs reported to UNOS since 4/1/94, of which 4,732 were from donors aged ≥55 years. Outcome measures were graft survival, serum creatinine, and incidence of delayed graft function with 3 years of follow-up. We first analyzed the effect of hypertension on outcome from donors ≥55 years: 2679 donors had no hypertension, 1058 had hypertension ≤10 years, and 557 had hypertension >10 years. Next, the effect of donor C Cr as a risk predictor was investigated. Based on this analysis, recipients of older donors were grouped into two cohorts for comparison: 2570 donors with C Cr Cr Actuarial graft survival from donors aged P Long-standing hypertension and low calculated creatinine clearance are risk factors for decreased graft survival of CRTs from older donors. When both factors are present, graft survival is significantly decreased.