Survival benefit from kidney transplantation depends on the donor source

According to ERA registry data, kidney transplantation, compared with continuous dialysis, leads to improved survival in recipients regardless of age, comorbid diabetes, or cardiovascular disease, provided the donor source is based on standard criteria; however, this benefit may not be maintained in expanded criteria.

The analysed patient population, based on the ERA registry, totalled 64,013 adults on dialysis waitlisted for a first deceased donor kidney transplant between 2000–2019 in France, the United Kingdom, Denmark, Norway, and Catalonia. Prof. Rachel Hellemans (Antwerp University Hospital, Belgium) and colleagues examined 5-year survival outcomes with transplantation versus continued dialysis, according to donor type and patient characteristics [1]. “To avoid biases we used target trial emulation, in which observational data are used to mimic a randomised controlled trial,” said Prof. Hellemans.

Using this methodology, the 5-year survival was higher for transplant recipients who received kidneys according to standard criteria (brain death or cardiovascular death) compared with patients on dialysis, and the benefit was maintained with advancing age of the recipient, regardless of diabetes or cardiovascular comorbidity. However, the results were not similar if the kidney was received from an expanded criteria donor (all deceased donors ≥60 years or deceased between 50–59 years and with at least 2 of either arterial hypertension, death from a cerebrovascular accident, or last serum creatinine >1.5 mg/dL). For these recipients, the survival benefit of transplantation tended to decrease compared with dialysis. These trends were also seen among patients who had comorbid diabetes or cardiovascular disease history.

“Our study confirms that there is still a universal survival benefit with standard criteria donor transplantation even in older patients with diabetes or cardiovascular disease,” concluded Prof. Hellemans. “For older patients in an expanded criteria, there may be little to no survival benefit in some settings; although this remains very hard to predict at an individual patient level.”

1. Hellemans R, et al. Exploring the margins of survival benefit in deceased donor kidney transplantation: An international target trial emulation. 62nd ERA Congress, 4–7 June 2025, Vienna, Austria.

Medical writing support was provided by Mihai Surducan, PhD.

Copyright ©2025 Medicom Medical Publishers



Posted on 6 June 202522 August 2025