{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:13:14Z","timestamp":1790107994134,"version":"4.0.1"},"reference-count":39,"publisher":"S. Karger AG","issue":"6","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nephron"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;\/i&gt;&lt;\/b&gt; 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 &amp;#x3e;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. &lt;b&gt;&lt;i&gt;Methods:&lt;\/i&gt;&lt;\/b&gt; In this single-center cohort study, we compared outcomes of 98 patients who received one or two biopsy-evaluated grafts from older\/marginal donors (\u201crecipients\u201d) and 198 patients who received nonhistologically assessed single graft from ideal donors (\u201creference-recipients\u201d) from October 2004 to December 2015 at the Bergamo Transplant Center (Italy). &lt;b&gt;&lt;i&gt;Results:&lt;\/i&gt;&lt;\/b&gt; 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\u201388.6) 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\u20132.08]), 5-year death-censored graft survival (94.3% [87.8\u2013100.0] vs. 94.2% [90.5\u201398.0]), BPAR incidence (rate ratio 0.87 [0.49\u20131.62]), and yearly measured glomerular filtration rate decline (1.18 \u00b1 3.27 vs. 0.68 \u00b1 2.42 mL\/min\/1.73 m&lt;sup&gt;2&lt;\/sup&gt;, &lt;i&gt;p&lt;\/i&gt; = 0.37) were similar between recipients and reference-recipients, respectively. &lt;b&gt;&lt;i&gt;Conclusions:&lt;\/i&gt;&lt;\/b&gt; 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. <\/jats:p>","DOI":"10.1159\/000516534","type":"journal-article","created":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T21:00:32Z","timestamp":1623790832000},"page":"642-652","source":"Crossref","is-referenced-by-count":10,"title":["Long-Term Outcomes of Kidney Transplants from Older\/Marginal Donors: A Cohort Study"],"prefix":"10.1159","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1925-7506","authenticated-orcid":false,"given":"Boris","family":"Bikbov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Ruggenenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Perna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norberto","family":"Perico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliana","family":"Gotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AnnaRita","family":"Plati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Gaspari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Carrara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Gambara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobia","family":"Peracchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rossini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Rota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Lacanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Amaduzzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Colledan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Remuzzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"key":"ref1","unstructured":"Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S, et al. OPTN\/SRTR 2018 Annual Data Report: kidney. <X00_Journal>Am J Transplant<\/X00_Journal>. 2020 Jan;20(Suppl s1):20\u2013130."},{"key":"ref2","unstructured":"Brennan C, Husain SA, King KL, Tsapepas D, Ratner LE, Jin Z, et al. A donor utilization index to assess the utilization and discard of deceased donor kidneys perceived as high risk. <X00_Journal>Clin J Am Soc Nephrol<\/X00_Journal>. 2019 Nov 7;14(11):1634\u201341."},{"key":"ref3","unstructured":"Rosengard BR, Feng S, Alfrey EJ, Zaroff JG, Emond JC, Henry ML, et al. Report of the Crystal City meeting to maximize the use of organs recovered from the cadaver donor. <X00_Journal>Am J Transplant<\/X00_Journal>. 2002 Sep;2(8):701\u201311."},{"key":"ref4","unstructured":"Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. <X00_Journal>J Am Soc Nephrol<\/X00_Journal>. 2001 Mar;12(3):589\u201397."},{"key":"ref5","unstructured":"Aubert O, Kamar N, Vernerey D, Viglietti D, Martinez F, Duong-Van-Huyen JP, et al. Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study. <X00_Journal>BMJ<\/X00_Journal>. 2015 Jul 31;351:h3557."},{"key":"ref6","unstructured":"Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. <X00_Journal>Transplantation<\/X00_Journal>. 2009 Jul 27;88(2):231\u20136."},{"key":"ref7","unstructured":"Tanriover B, Mohan S, Cohen DJ, Radhakrishnan J, Nickolas TL, Stone PW, et al. Kidneys at higher risk of discard: expanding the role of dual kidney transplantation. <X00_Journal>Am J Transplant<\/X00_Journal>. 2014 Feb;14(2):404\u201315."},{"key":"ref8","unstructured":"Bae S, Massie AB, Luo X, Anjum S, Desai NM, Segev DL. Changes in discard rate after the introduction of the Kidney Donor Profile Index (KDPI). <X00_Journal>Am J Transplant<\/X00_Journal>. 2016 Jul;16(7):2202\u20137."},{"key":"ref9","unstructured":"Remuzzi G, Griny\u00f2 J, Ruggenenti P, Beatini M, Cole EH, Milford EL, et al. Early experience with dual kidney transplantation in adults using expanded donor criteria. Double Kidney Transplant Group (DKG). <X00_Journal>J Am Soc Nephrol<\/X00_Journal>. 1999 Dec;10(12):2591\u20138."},{"key":"ref10","unstructured":"Remuzzi G, Cravedi P, Perna A, Dimitrov BD, Turturro M, Locatelli G, et al. Long-term outcome of renal transplantation from older donors. <X00_Journal>N Engl J Med<\/X00_Journal>. 2006 Jan 26;354(4):343\u201352."},{"key":"ref11","unstructured":"Rigotti P, Ekser B, Furian L, Baldan N, Valente ML, Boschiero L, et al. Outcome of renal transplantation from very old donors. <X00_Journal>N Engl J Med<\/X00_Journal>. 2009 Apr 2;360(14):1464\u20135."},{"key":"ref12","unstructured":"Pierobon ES, Sefora PE, Sandrini S, Silvio S, De Fazio N, Nicola de F, et al. Optimizing utilization of kidneys from deceased donors over 60 years: five-year outcomes after implementation of a combined clinical and histological allocation algorithm. <X00_Journal>Transpl Int<\/X00_Journal>. 2013 Aug;26(8):833\u201341."},{"key":"ref13","unstructured":"Gaspari F, Perico N, Ruggenenti P, Mosconi L, Amuchastegui CS, Guerini E, et al. Plasma clearance of nonradioactive iohexol as a measure of glomerular filtration rate. <X00_Journal>J Am Soc Nephrol<\/X00_Journal>. 1995 Aug;6(2):257\u201363."},{"key":"ref14","unstructured":"Gaspari F, Thakar S, Carrara F, Perna A, Trillini M, Aparicio MC, et al. Safety of iohexol administration to measure glomerular filtration rate in different patient populations: a 25-year experience. <X00_Journal>Nephron<\/X00_Journal>. 2018;140(1):1\u20138."},{"key":"ref15","unstructured":"Pattaro C, Riegler P, Stifter G, Modenese M, Minelli C, Pramstaller PP. Estimating the glomerular filtration rate in the general population using different equations: effects on classification and association. <X00_Journal>Nephron Clin Pract<\/X00_Journal>. 2013;123(1\u20132):102\u201311."},{"key":"ref16","unstructured":"Bikbov B. R open source programming code for calculation of the kidney donor profile index and kidney donor risk index. <X00_Journal>Kidney Dis<\/X00_Journal>. 2018 Nov;4(4):269\u201372."},{"key":"ref17","unstructured":"Granerus G, Aurell M. Reference values for 51Cr-EDTA clearance as a measure of glomerular filtration rate. <X00_Journal>Scand J Clin Lab Invest<\/X00_Journal>. 1981 Oct;41(6):611\u20136."},{"key":"ref18","unstructured":"Pottel H, Delanaye P, Weekers L, Selistre L, Goffin K, Gheysens O, et al. Age-dependent reference intervals for estimated and measured glomerular filtration rate. <X00_Journal>Clin Kidney J<\/X00_Journal>. 2017 Aug;10(4):545\u201351."},{"key":"ref19","unstructured":"Terasaki PI, Gjertson DW, Cecka JM, Takemoto S. Fit and match hypothesis for kidney transplantation. <X00_Journal>Transplantation<\/X00_Journal>. 1996 Aug 27;62(4):441\u20135."},{"key":"ref20","unstructured":"Brenner BM, Milford EL. Nephron underdosing: a programmed cause of chronic renal allograft failure. <X00_Journal>Am J Kidney Dis<\/X00_Journal>. 1993 May;21(5 Suppl 2):66\u201372."},{"key":"ref21","unstructured":"Moreso F, Ser\u00f3n D, Gil-Vernet S, Riera L, Fulladosa X, Ramos R, et al. Donor age and delayed graft function as predictors of renal allograft survival in rejection-free patients. <X00_Journal>Nephrol Dial Transplant<\/X00_Journal>. 1999 Apr;14(4):930\u20135."},{"key":"ref22","unstructured":"Lee CM, Carter JT, Randall HB, Hiose R, Stock PG, Melzer JS, et al. The effect of age and prolonged cold ischemia times on the national allocation of cadaveric renal allografts. <X00_Journal>J Surg Res<\/X00_Journal>. 2000 Jun 1;91(1):83\u20138."},{"key":"ref23","unstructured":"de Fijter JW, Mallat MJ, Doxiadis II, Ringers J, Rosendaal FR, Claas FH, et al. Increased immunogenicity and cause of graft loss of old donor kidneys. <X00_Journal>J Am Soc Nephrol<\/X00_Journal>. 2001 Jul;12(7):1538\u201346."},{"key":"ref24","unstructured":"Vianello A, Mastrosimone S, Calconi G, da Porto A, Palminteri G, D\u2019Annibale A, et al. Influence of donor age on cadaver kidney graft function and survival: univariate and multivariate analyses. <X00_Journal>Nephron<\/X00_Journal>. 1993;65(4):541\u20138."},{"key":"ref25","unstructured":"Frei U, Noeldeke J, Machold-Fabrizii V, Arbogast H, Margreiter R, Fricke L, et al. Prospective age-matching in elderly kidney transplant recipients--a 5-year analysis of the Eurotransplant Senior Program. <X00_Journal>Am J Transplant<\/X00_Journal>. 2008 Jan;8(1):50\u20137."},{"key":"ref26","unstructured":"Boesmueller C, Biebl M, Scheidl S, Oellinger R, Margreiter C, Pratschke J, et al. Long-term outcome in kidney transplant recipients over 70 years in the Eurotransplant Senior Kidney Transplant Program: a single center experience. <X00_Journal>Transplantation<\/X00_Journal>. 2011 Jul 27;92(2):210\u20136."},{"key":"ref27","unstructured":"Jerius JT, Taylor RJ, Murillo D, Leone JP. Double renal transplants from marginal donors: 2-year results. <X00_Journal>J Urol<\/X00_Journal>. 2000 Feb;163(2):423\u20135."},{"key":"ref28","unstructured":"Dietl KH, Wolters H, Marschall B, Senninger N, Heidenreich S. Cadaveric \u201ctwo-in-one\u201d kidney transplantation from marginal donors: experience of 26 cases after 3 years. <X00_Journal>Transplantation<\/X00_Journal>. 2000 Sep 15;70(5):790\u20134."},{"key":"ref29","unstructured":"Ruggenenti P, Silvestre C, Boschiero L, Rota G, Furian L, Perna A, et al. Long-term outcome of renal transplantation from octogenarian donors: a multicenter controlled study. <X00_Journal>Am J Transplant<\/X00_Journal>. 2017 Dec;17(12):3159\u201371."},{"key":"ref30","unstructured":"Kasiske BL, Stewart DE, Bista BR, Salkowski N, Snyder JJ, Israni AK, et al. The role of procurement biopsies in acceptance decisions for kidneys retrieved for transplant. <X00_Journal>Clin J Am Soc Nephrol<\/X00_Journal>. 2014 Mar;9(3):562\u201371."},{"key":"ref31","unstructured":"Carpenter D, Husain SA, Brennan C, Batal I, Hall IE, Santoriello D, et al. Procurement biopsies in the evaluation of deceased donor kidneys. <X00_Journal>Clin J Am Soc Nephrol<\/X00_Journal>. 2018 Dec 7;13(12):1876\u201385."},{"key":"ref32","unstructured":"Cofan F, Oppenheimer F, Campistol JM, Flores R, Vilardell J, Ricart MJ, et al. Advanced age donors in the evolution of renal transplantation. <X00_Journal>Transplant Proc<\/X00_Journal>. 1995 Aug;27(4):2248\u20139."},{"key":"ref33","unstructured":"Basar H, Soran A, Shapiro R, Vivas C, Scantlebury VP, Jordan ML, et al. Renal transplantation in recipients over the age of 60: the impact of donor age. <X00_Journal>Transplantation<\/X00_Journal>. 1999 Apr 27;67(8):1191\u20133."},{"key":"ref34","unstructured":"Matas AJ, Gillingham K, Payne WD, Humar A, Dunn DL, Sutherland DE, et al. Should I accept this kidney? <X00_Journal>Clin Transplant<\/X00_Journal>. 2000 Feb;14(1):90\u20135."},{"key":"ref35","unstructured":"Rege A, Irish B, Castleberry A, Vikraman D, Sanoff S, Ravindra K, et al. Trends in usage and outcomes for expanded criteria donor kidney transplantation in the United States characterized by kidney donor profile index. <X00_Journal>Cureus<\/X00_Journal>. 2016 Nov 22;8(11):e887."},{"key":"ref36","unstructured":"Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. <X00_Journal>Am J Transplant<\/X00_Journal>. 2011 Oct;11(10):2093\u2013109."},{"key":"ref37","unstructured":"Kaballo MA, Canney M, O\u2019Kelly P, Williams Y, O\u2019Seaghdha CM, Conlon PJ. A comparative analysis of survival of patients on dialysis and after kidney transplantation. <X00_Journal>Clin Kidney J<\/X00_Journal>. 2018 Jun;11(3):389\u201393."},{"key":"ref38","unstructured":"Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. <X00_Journal>Transplantation<\/X00_Journal>. 2002 Nov 27;74(10):1377\u201381."},{"key":"ref39","unstructured":"Porrini E, Ruggenenti P, Luis-Lima S, Carrara F, Jim\u00e9nez A, de Vries APJ, et al. Estimated GFR: time for a critical appraisal. <X00_Journal>Nat Rev Nephrol<\/X00_Journal>. 2019 Mar;15(3):177\u201390."}],"container-title":["Nephron"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/516534","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/516534","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T14:56:37Z","timestamp":1745420197000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000516534"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,11,11]]},"published-print":{"date-parts":[[2021,11,16]]}},"URL":"https:\/\/doi.org\/10.1159\/000516534","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.14784795","asserted-by":"subject"}]},"ISSN":["1660-8151","2235-3186"],"issn-type":[{"value":"1660-8151","type":"print"},{"value":"2235-3186","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021]]}}}