Kidney transplant survival advantage varied by donor and age
Among 75-year-olds, estimated five-year survival was 59% after expanded-criteria donor transplants following circulatory death versus 55% with continued dialysis, without a statistically clear difference.
5 years, multicenter
Limit: Unrecorded changes in frailty and cardiovascular risk could inflate the estimated transplant survival benefit
Stake: Authors hold shares in Novo Nordisk.
Edited by Boris Djordjevic · AgingResearch.News
An observational analysis used data on 64,036 patients aged 20 or older receiving dialysis to filter their blood and waitlisted for a first kidney-only transplant from a deceased donor. Researchers used registry data from five European countries or regions for 2000–2019 to emulate a trial comparing transplantation with continued dialysis. Overall, 39,244 patients received a transplant.
Kidneys in the standard-criteria donor-quality category were associated with higher estimated five-year survival than dialysis across recipient ages. For the expanded-criteria category, the estimated advantage declined with age, especially after donation following circulatory death, when blood circulation has stopped. Among 75-year-olds in that latter group, the range of likely effects included no survival difference. This group had threefold higher early mortality after transplantation than those continuing dialysis.
Why it matters
For older people on kidney transplant waiting lists, the findings bear on whether the chance of surviving longer differs by the type of kidney offered.
Caveats
This observational analysis emulated a trial but did not randomly assign patients, so it cannot establish cause and effect. The findings concern patients aged 20 or older already waitlisted for a first deceased donor kidney-only transplant, with greater uncertainty among older patients.
From the paper
- Participants
The cohort comprised 64 036 patients (table 1; supplementary figure S1).
- Result
… standard criteria donor/donation after brain death transplantation was associated with a 32% lower mortality rate (hazard ratio 0.68, 95% confidence interval (CI) 0.59 to 0.79) …
Results, Survival in kidney transplantation versus remaining on dialysis
- Limitation
Firstly, the generalisability of our findings should be considered, as dialysis and transplant outcomes could vary over time, by region, and between centres, reflecting differences in patient selection and quality of care.
Quoted word for word from the full text on bmj.com.
The paper
University of Antwerp; Amsterdam Public Health
BMJ, Sep 18, 2026, Open access
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