Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: a study by the ERA-EDTA Registry

Eternal Youth: A Comprehensive Exploration of Gene, Cellular, and Pharmacological Anti-Aging Strategies

The improvement of human living conditions has led to an increase in average life expectancy, creating a new social and medical problem-aging, which diminishes the overall quality of human life. The aging process of the body begins with the activation of effector signaling pathways of aging in cells, resulting in the loss of their normal functions and deleterious effects on the microenvironment. This, in turn, leads to chronic inflammation and similar transformations in neighboring cells. The cumulative retention of these senescent cells over a prolonged period results in the deterioration of tissues and organs, ultimately leading to a reduced quality of life and an elevated risk of mortality. Among the most promising methods for addressing aging and age-related illnesses are pharmacological, genetic, and cellular therapies. Elevating the activity of aging-suppressing genes, employing specific groups of native and genetically modified cells, and utilizing senolytic medications may offer the potential to delay aging and age-related ailments over the long term. This review explores strategies and advancements in the field of anti-aging therapies currently under investigation, with a particular emphasis on gene therapy involving adeno-associated vectors and cell-based therapeutic approaches.

Effect of Utilizing More Than 20-Year Older Deceased Donor Kidneys for Young Recipients: An Analysis of the UK Registry

OBJECTIVES

Despite the wider acceptance of expanded criteria kidneys and the advances in immunosuppression, clinicians remain sceptical when it comes to accepting kidneys from significantly older donors, especially for the young adult recipient population (age ≤40 years).

MATERIALS AND METHODS

We utilized prospectively maintained data from the United Kingdom Registry and analyzed the deceased donor renal transplant outcomes for 2 cohorts: (1) young recipients who received either a younger kidney or a kidney from a donor who was less than 20 years older (group <20; n = 2072) and (2) young recipients who received a kidney from donors who were 20 or more years older (group ≥20, n = 764). We used life tables for survival and performed Cox regression analysis to identify significant variables.

RESULTS

Median follow-up was 2918 days. The univariate analysis for graft loss showed the strongest predictors to be donor age, recipient age, recipient ethnicity, and delayed graft function, which retained their significance in the multivariate model. Graft survival rates were 94% versus 90% at 1 year, 86% versus 75% at 5 years, and 75% versus 63% at 10 years for group <20 versus group ≥20, respectively. Respective patient survival rates were comparable for both cohorts: 99% versus 98% at 1 year, 97% versus 96% at 5 years, and 91% versus 91% at 10 years.

CONCLUSIONS

Our analysis showed that allografts from ≥20-year-older deceased donors are beneficial and should be considered for transplant in younger recipients. Allograft survival may be worse compared with survival with younger allografts; however, young recipients do potentially better and survive longer compared with remaining on dialysis.

The association of living donor source with patient and graft survival among kidney transplant recipients in the ERA-EDTA Registry - a retrospective study

In this study we aimed to compare patient and graft survival of kidney transplant recipients who received a kidney from a living‐related donor (LRD) or living‐unrelated donor (LUD). Adult patients in the ERA‐EDTA Registry who received their first kidney transplant in 1998–2017 were included. Ten‐year patient and graft survival were compared between LRD and LUD transplants using Cox regression analysis. In total, 14 370 patients received a kidney from a living donor. Of those, 9212 (64.1%) grafts were from a LRD, 5063 (35.2%) from a LUD and for 95 (0.7%), the donor type was unknown. Unadjusted five‐year risks of death and graft failure (including death as event) were lower for LRD transplants than for LUD grafts: 4.2% (95% confidence interval [CI]: 3.7–4.6) and 10.8% (95% CI: 10.1–11.5) versus 6.5% (95% CI: 5.7–7.4) and 12.2% (95% CI: 11.2–13.3), respectively. However, after adjusting for potential confounders, associations disappeared with hazard ratios of 0.99 (95% CI: 0.87–1.13) for patient survival and 1.03 (95% CI: 0.94–1.14) for graft survival. Unadjusted risk of death‐censored graft failure was similar, but after adjustment, it was higher for LUD transplants (1.19; 95% CI: 1.04–1.35). In conclusion, patient and graft survival of LRD and LUD kidney transplant recipients was similar, whereas death‐censored graft failure was higher in LUD. These findings confirm the importance of both living kidney donor types.