1. Renal transplantation from cadaveric donors older than 65y -Multicenter retrospective study- Josep Lloveras, Emma Arcos*, Jordi Comas*, Julio Pascual Nephrology Dept. Hospital del Mar. Autonomous University of Barcelona * Registre de Malalts Renals de Catalunya/Organització Catalana de Trasplantaments

2. Long term results of 835 RT patients from cadaveric donors >65y (1990-2009) Total number: 4.974 RT (cadaveric, 1 st graft) RT donors <65y: 4.139 (83.2%) RT donors >65y: 835 (16.8%) Donors aged 65y-70y: 324 (38.8%) - (6.5%) 70y-75y: 347 (41.5%) - (7.0%) >75y: 164 (19.7%) - (3.3%)

3. Donor population characteristics (I) -donor sex by age- p<0.001

4. Donor population characteristics (II) -cause of death by age-

5. Donor population characteristics (III)* -GFR by age- * Cases 2000-2009 (n=2,721) p<0.001

6. Donor population characteristics (IV)* -GFR by sex- * Cases 2000-2009 (n=2,721) p<0.001

7. Donor – Recipient age matching* 89% of kidneys from donors >65y went to recipients >60y

8. Recipient population characteristics (I) -time on dialysis by age-

9. Recipient population characteristics (II) -Panel Reactive Antibodies (PRA)-

10. Recipient population characteristics (III) -HLA Ag compatibilities-

11. Recipient population characteristics (IV) -cold ischemia time by age-

12. Recipient population characteristics (V) -delayed graft function by age- p<0.001

13. Recipient population characteristics (VI) -first admission immunosuppressive treatment by age-

16. Patient survival by donor age (I) Donor age 1st 5th 9th 98,9% 95,8% 90,4% 98,0% 91,5% 81,9% 93,9% 87,1% 66,1% 94,1% 78,9% 54,7% 92,8% 81,7% 61,3% 91,9% 75,3%

17. Graft survival by donor age (II) Donor age 1st 5th 9th 94,9% 86,1% 75,7% 91,8% 81,3% 67,1% 88,4% 77,3% 55,5% 89,3% 62,4% 42,3% 84,2% 68,0% 48,3% 81,3% 54,4%

18. Graft survival by donor age (death censored) (III) Donor age 1st 5th 9th 95,9% 88,7% 81,6% 93,2% 87,0% 78,7% 93,8% 86,7% 79,2% 93,0% 75,5% 62,0% 90,9% 79,9% 66,9% 88,2% 68,2%

19. Comparing survival of patients reciving kidneys from donors >65y with survival of patients remaining on Dialysis (I) Time Period: 1997-2009 Inclusion Criteria: patients starting Dialysis after 1997 and presenting normal and nearly normal degree of functional autonomy. Total number: 772 pats. Methology: Paired Design. - Group A: 386 transplanted pats. - Group B: 386 pats. remaining on Dialysis.

20. We used the following variables*: Year period of Dialysis onset Age group Diabetes First Vascular Access Time on Dialysis Primary renal Disease (Standard, Others, Diabetic nephropathy) Morbidity*: Cardiovascular disease, tumors, chronic liver disease. Both groups presented the same gender and chronic respiratory disease distribution. * Morbidity prior to transplant in RT patients and morbidity at the same time in dialysis patients. Comparing survival of patients reciving kidneys from donors >65y with survival of patients remaining on Dialysis(II) Pairing Criteria: Characteristics must be identical in both groups, patient by patient using a parametric survival model.

21. Comparing survival of patients reciving kidneys from donors >65y with survival of patients remaining on Dialysis (III) Statistical analysis: Kaplan Meier curve for patient survival in both groups. Cox model clustering by paired patients and robust estimation of variance for estimation of proportional risk of death of a patient remaining on HD compared with RT patients.

22. Comparing patient survival of RT from donors >65 with survival of patients remaining on HD (IV) A patient remaining on dialysis has a proportional risk of death three times greater than a transplanted patient. YEARS Transplant Dialysis 1 93,10% 90,80% 3 89,50% 70,80% 5 83,00% 54,60% 9 66,00% 30,30%

24. Global graft survival in deceased RT by periods: 1984-1989, 1990-1997 and 1998-2009 Source: Catalan Renal Registry. Statistical report 2009

25. Global graft survival according to donor and recipient age. (1990-2009) Source: Catalan Renal Registry. Statistical report 2009

26. Global graft survival according to donor and recipient sex. (1990-2009) Source: Catalan Renal Registry. Statistical report 2009

27. Recipient population characteristics (I) -primary renal disease distribution by age- p<0.001

28. Patient survival by donor age (II) Cox regression Univariate Hazard Ratio (95%CI) p-value Donor Age <45 1 [45-54] 1,97 ( 1,33; 2,93) 0,001 [55-64] 3,85 ( 2,73; 5,45) 0,000 [65-69] 5,44 ( 3,60; 8,23) 0,000 [70-75] 4,74 ( 3,15; 7,14) 0,000 >75 7,35 ( 4,50;12,00) 0,000 >=100 1 91-99 0,73 ( 0,43; 1,25) 0,249 80-90 1,59 ( 1,05; 2,41) 0,029 <80 1,65 (1,24; 2,20) 0,001

29. Graft survival by donor age (II) Cox regression Univariate Hazard Ratio (95%CI) p-value Donor Age <45 1 [45-54] 1,36 ( 1,06; 1,75) 0,015 [55-64] 1,94 ( 1,54; 2,43) 0,000 [65-69] 2,75 ( 2,05; 3,68) 0,000 [70-75] 2,43 ( 1,83; 3,24) 0,000 >75 3,84 ( 2,70; 5,45) 0,000 >=100 1 91-99 0,68 ( 0, 46; 0,99) 0,045 80-90 1,41 ( 1,04; 1,90) 0,026 <80 1,36 ( 1,11;1,67) 0,003

30. Graft survival by donor age (death censored) (II) Cox regression Univariate Hazard Ratio (95%CI) p-value Donor Age <45 1 [45-54] 1,17 ( 0,87; 1,58) 0,299 [55-64] 1,25 ( 0,94; 1,67) 0,120 [65-69] 2,14 ( 1,50; 3,06) 0,000 [70-75] 1,78 ( 1,24; 2,55) 0,002 >75 2,77 ( 1,78; 4,32) 0,000 >=100 1 91-99 0,75 ( 0,47; 1,19) 0,217 80-90 1,51 ( 1,05; 2,18) 0,027 <80 1,34 ( 1,04; 1,74) 0,025

31. Recipient population characteristics (VII) -first admission immunosuppressive treatment by age-

32. Donor – Recipient sex matching by recipient age p<0.001

33. Recipient population characteristics (I) -Primary renal disease in ESRD-

34. Recipient population characteristics (IV) -time on dialysis-

35. Recipient population characteristics (VI) -cold ischemia time-

36. Graft survival 1984-1989//1990-1997//1998-2009 Source: Catalan Renal Registry. Statistical report 2009