Study Uncovers Limitations of Kidney Transplant Survival in Older and High-Risk Patients

A comprehensive international study presented at the 62nd ERA Congress reveals that while kidney transplantation generally offers a survival advantage, this benefit varies significantly among different patient groups, especially the elderly and those receiving high-risk donor organs. The research, utilizing data from the European Renal Association (ERA) Registry, analyzed five-year outcomes for over 64,000 adults on dialysis across multiple European countries, including Catalonia, Denmark, France, Norway, and the UK, who started treatment between 2000 and 2019.

Employing a sophisticated target trial emulation (TTE) framework designed to mimic randomized controlled trials, researchers compared long-term survival rates between patients who received kidney transplants and those who remained on dialysis. Lead researcher Dr. Rachel Hellemans emphasized that this approach reduced many biases inherent in traditional registry studies, providing clearer insights into transplant outcomes.

Results indicated that standard-criteria donor kidneys—those from donors younger than 60 without risk factors—consistently improved survival across most age groups and health statuses. Conversely, the advantages become less pronounced in older recipients, particularly those aged 75 and above, where five-year survival rates only marginally exceeded those on dialysis (around 57-58% versus 54%). Factors such as cardiovascular disease and the use of kidneys from donors after circulatory death further diminished transplant benefits in these populations.

A critical finding was the higher early post-transplant mortality in high-risk patients, especially within the initial months following surgery. Frailty, surgical risks, and intensified immunosuppressive treatments can overshadow the long-term benefits, making survival gains less predictable for this group. Dr. Hellemans pointed out that the survival advantage plateaus for very old or high-risk patients, especially those receiving expanded-criteria donor (ECD) organs, which may come from older donors or those with risk factors affecting organ quality.

This nuanced understanding offers vital guidance for clinicians and patients, suggesting that age and health conditions should inform transplantation decisions. The message is not to avoid transplant in older people but to have transparent discussions about the potential marginal benefits, especially when transplant risks are higher.

Overall, this study underscores the importance of personalized assessments in kidney transplantation, highlighting that the procedure's success and benefits are not uniform across all patient groups. It calls for careful consideration of individual health profiles and donor organ quality when evaluating the viability and expected outcomes of transplantation.

For further details, the study titled "Exploring the Margins of Survival Benefit in Deceased Donor Kidney Transplantation" by Dr. Rachel Hellemans and colleagues provides in-depth analysis of these findings. [source: https://medicalxpress.com/news/2025-06-reveals-survival-limits-kidney-transplantation.html]