Evaluation of the older cadaveric kidney donor: The impact of donor hypertension and creatinine clearance on graft performance and survival

Background. The use of older donors for cadaveric renal transplantation (CR T) remains controversial because older donors are associated with decreased graft survival, yet offer the opportunity for donor pool expansion. We inv estigated the impact of two age-related donor factors, hypertension and cal culated creatinine clearance (C-Cr), as predictors of graft outcome in reci pients of CRTs from donors greater than or equal to 55 years of age. Methods. We reviewed 33,595 recipients of CRTs reported to UNOS since 4/1/9 4, of which 4,732 were from donors aged greater than or equal to 55 years. Outcome measures were graft survival, serum creatinine, and incidence of de layed graft function with 3 years of follow-up. We first analyzed the effec t of hypertension on outcome from donors greater than or equal to 55 years: 2679 donors had no hypertension, 1058 had hypertension less than or equal to 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, recipien ts of older donors were grouped into two cohorts for comparison: 2570 donor s with C-Cr <80 ml/min and 2162 donors with C-Cr greater than or equal to 8 0 ml/min. Results. Actuarial graft survival from donors aged <55 years was 88.0, 83.4 , and 78.5% at 1, 2, and 3 years, vs. 80.6, 73.5, and 65.3% from donors gre ater than or equal to 55 years (P<0.0001). When stratified by hypertension, older donors hypertensive >10 years had survivals of 77, 66, and 57% vs. 8 1, 73, and 65% from donors without hypertension (P<0.017) and 80, 74, and 6 6% from donors hypertensive <10 years (P<0.017). When stratified by C-Cr, o lder donors with C-Cr <80 ml/min had survivals of 77, 69, and 62% vs. 83, 7 6, and 66% from donors with C-Cr greater than or equal to 80 (P<0.0001). Fi nally, older donors with both hypertension less than or equal to 10 years a nd C-Cr <80 ml/min had survivals of 77, 61, and 53%. Conclusions. Long-standing hypertension and low calculated creatinine clear ance are risk factors for decreased graft survival of CRTs from older donor s. When both factors are present, graft survival is significantly decreased .