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Supplementary Material for: Long-Term Outcomes of Kidney Transplants from Older/Marginal Donors: A Cohort Study

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posted on 15.06.2021, 09:51 by Bikbov B., Ruggenenti P., Perna A., Perico N., Gotti E., Plati A.R., Gaspari F., Carrara F., Gambara V., Peracchi T., Rossini G., Rota G., Lacanna F., Amaduzzi A., Colledan M., Remuzzi G.
Introduction: To safely expand the donor pool, we introduced a strategy of biopsy-guided selection and allocation to single or dual transplantation of kidneys from donors >60 years old or with hypertension, diabetes, and/or proteinuria (older/marginal donors). Here, we evaluated the long-term performance of this approach in everyday clinical practice. Methods: In this single-center cohort study, we compared outcomes of 98 patients who received one or two biopsy-evaluated grafts from older/marginal donors (“recipients”) and 198 patients who received nonhistologically assessed single graft from ideal donors (“reference-recipients”) from October 2004 to December 2015 at the Bergamo Transplant Center (Italy). Results: Older/marginal donors and their recipients were 27.9 and 19.3 years older than ideal donors and their reference-recipients, respectively. KDPI/KDRI and donor serum creatinine were higher and cold ischemia time longer in the recipient group. During a median follow-up of 51.9 (interquartile range 23.1–88.6) months, 11.2% of recipients died, 7.1% lost their graft, and 16.3% had biopsy-proven acute rejection (BPAR) versus 3.5, 7.6, and 17.7%, respectively, of reference-recipients. Overall death-censored graft failure (rate ratio 0.78 [95% CI 0.33–2.08]), 5-year death-censored graft survival (94.3% [87.8–100.0] vs. 94.2% [90.5–98.0]), BPAR incidence (rate ratio 0.87 [0.49–1.62]), and yearly measured glomerular filtration rate decline (1.18 ± 3.27 vs. 0.68 ± 2.42 mL/min/1.73 m2, p = 0.37) were similar between recipients and reference-recipients, respectively. Conclusions: Biopsy-guided selection and allocation of kidneys from older/marginal donors can safely increase transplant activity in clinical practice without affecting long-term outcomes. This may help manage the growing gap between organ demand and supply without affecting long-term recipient and graft outcomes.