FO050TWO DECADES OF EUROTRANSPLANT SENIOR PROGRAM (ESP): TIME ON DIALYSIS INDEPENDENTLY IMPACTS PATIENT SURVIVAL, ALLOGRAFT SURVIVAL AND QUALITY OF LIFE AFTER KIDNEY TRANSPLANTATION

Abstract

In 1999, the Eurotransplant Senior Program (ESP) was implemented and allocates kidneys from deceased-donors ≥65 years to kidney transplant recipients ≥65 years (ESP-KTRs). The ESP aims to shorten cold ischemic time by leaving out HLA matching and regional allocation. We analyzed patient and allograft outcomes of 244 ESP-KTRs between 1999 and 2017. All ESP-KTRs were assessed by a questionnaire-based survey using the standardized short form-8 questionnaire. A control group of 82 dialysis patients waitlisted within the ESP was used for comparison. We observed 1-, 5-, and 10-year patient survival of 92.5%, 67.6%, and 38.2%, respectively. Upon multivariate analysis mortality risk factors included prolonged initial hospital stay (p=0.004), male gender (p=0.017), and time on dialysis (p=0.012). 1-, 5-, and 10-year death-censored allograft survival was 92.1%, 81.0%, and 70.0%, respectively. Risk factors that were independently associated with allograft loss included time on dialysis (p<0.001) and acute cellular rejection (p<0.001). After reinitiation of dialysis treatment among ESP-KTRs with allograft loss median patient survival was 46 months (range: 0-152). 45.1 % of ESP-KTRs showed delayed graft function and 3.7% of ESP-KTRs showed primary non-function. Allograft function at 1-, 5-, and 10-years were 44.6mL/min, 40.5mL/min, and 39.1mL/min, respectively. Median physical and mental component scores (PCS/MCS) of ESP-KTRs were signifi cantly higher compared to dialysis patients waitlisted within the ESP (p<0.05). The only factors, that were independently associated with inferior PCS and MCS were recipient age (p=0.013) and time on dialysis (p=0.043). 97% of ESP-KTRs who underwent successful kidney transplantation would choose again to do so. Kidney transplantation within the ESP shows highly favorable patient and allograft outcomes independent of recipient and donor age. However, prolonged time on dialysis signifi cantly impacts patient and allograft outcomes and accounts also for inferior quality of life after successful transplantation. This finding may be attributed to longer time from medical evaluation to transplantation among those ESP-KTRs and call for more frequent and critical medical re-evaluation.