Kidney transplant outcomes from older deceased donors: a paired kidney analysis by the European Renal Association-European Dialysis and Transplant Association Registry.

As the median age of deceased kidney donors rises, updated knowledge of transplant outcomes from older deceased donors in differing donor-recipient age groups is required. Using ERA-EDTA Registry data we determined survival outcomes of kidney allografts donated from the same older deceased donor (55-70 years), and transplanted into one recipient younger and one recipient of similar age to the donor. The recipient pairs were divided into two groups: group 1; younger (median age: 52 years) and older (60 years) and group 2; younger (41 years) and older (60 years). A total of 1410 adults were transplanted during 2000-2007. Compared to the older recipients, the mean number of functioning graft years at 10 years was 6 months longer in the group 1 and group 2 younger recipients (P < 0.001). Ten-year graft survival was 54% and 40% for the group 1 younger and older recipients, and 60% and 49% for the group 2 younger and older recipients. Paired Cox regression analyses showed a lower risk of graft failure (group 1 younger; adjusted relative risk [RRa]:0.57, 95% CI:0.41-0.79, and group 2 younger; RRa:0.63, 95% CI:0.47-0.85) in younger recipients. Outcomes from older deceased donor allografts transplanted into differing donor-recipient age groups are better than previously reported. These allografts remain a valuable transplant resource, particularly for similar-aged recipients.

Centre-specific variation in corneal transplant outcomes in the United Kingdom.

BACKGROUND: To examine the influence of center or surgeon transplant workload on corneal transplant outcome. METHODS: In this database study, centers were categorized as high or low volume if registering more than 50 and less than 10 corneal transplants per year, respectively; surgeons were categorized as high or low volume if registering more than 30 and less than 10 transplants per year, respectively. The participants were patients aged at least 17 years receiving a first penetrating keratoplasty for keratoconus, Fuchs' endothelial disease, or pseudophakic corneal edema in a 7-year period from 1999 in (1) high-volume (n=1724) and low-volume (n=2131) centers and (2) under care of high-volume (n=1332) and low-volume (n=1949) surgeons. Main outcome measures were (1) graft survival at 5 years and (2) 2-year posttransplant best-corrected and day-to-day visual acuity and astigmatism. RESULTS: No significant difference in graft survival was found according to center or surgeon workload. Statistically significantly better day-to-day visual acuity was found only in patients with Fuchs' endothelial disease managed by high-volume surgeons (20/40 or better in 50% vs. 42% for low-volume surgeons). There was statistically significantly better best-corrected visual acuity in high-volume centers for Fuchs' endothelial disease and pseudophakic corneal edema and for high-volume surgeons in all disease groups. CONCLUSIONS: Based on this national transplant cohort, when analyzed according to center volume or surgeon transplant workload, there is no variation in graft survival and only minor variation in transplant functional outcome.

The use of marginal heart beating donor livers for transplantation in the United kingdom.

BACKGROUND: This study investigated the use of deceased heart-beating donor livers offered for transplantation during a 10-year period, during which there has been an increasing disparity between organ supply and demand in the United Kingdom. METHODS: Summary data from the National Transplant Database were analyzed on all 7107 heart-beating cadaveric donor livers offered for transplantation in the United Kingdom between 1996 and 2006, with particular attention to livers that were not retrieved, not transplanted, or that subsequently failed to function after transplantation. RESULTS: The difference between the number of patients registered for liver transplantation in the United Kingdom and those transplanted increased from 132 in 1996 to 333 in 2006, leading to a 77% increase in the number of waiting list deaths. Mean donor age increased by 6.1 (5.7-6.6) years during the period studied, in part because of a reduction in the proportion of donors arising from road fatalities. Despite this, the rate of primary nonfunction remained low (1.7% during 1996-2006). The absolute risk increase of primary nonfunction arising from receipt of a moderately as opposed to mildly steatotic organ was 2.6%, which translates to a "number needed to harm" of 41 patients. CONCLUSIONS: The decline in both the number and the quality of livers offered for transplantation in the United Kingdom during the past 10 years has not been associated with a change in the rate of primary nonfunction. In these times of acute donor shortage, these data may justify a more liberal use of marginal grafts.