Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation
To address the shortage of organs for kidney transplantation, the Eurotransplant Senior Program (ESP) was established to enhance kidney allocation from elderly donors. This study aimed to evaluate post-transplant outcomes of deceased donor grafts and identify prognostic factors within the ESP popula...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2025-06-01
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| Series: | Transplant International |
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| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14153/full |
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| author | Tom N. Langer Tom N. Langer Thorsten Wiech Thorsten Wiech Mercedes Noriega Sergey Biniaminov Tobias B. Huber Tobias B. Huber Lutz Fischer Lutz Fischer Florian Grahammer Florian Grahammer Florian Grahammer Malte A. Kluger Malte A. Kluger |
| author_facet | Tom N. Langer Tom N. Langer Thorsten Wiech Thorsten Wiech Mercedes Noriega Sergey Biniaminov Tobias B. Huber Tobias B. Huber Lutz Fischer Lutz Fischer Florian Grahammer Florian Grahammer Florian Grahammer Malte A. Kluger Malte A. Kluger |
| author_sort | Tom N. Langer |
| collection | DOAJ |
| description | To address the shortage of organs for kidney transplantation, the Eurotransplant Senior Program (ESP) was established to enhance kidney allocation from elderly donors. This study aimed to evaluate post-transplant outcomes of deceased donor grafts and identify prognostic factors within the ESP population. We therefore analyzed patient data from 64 ESP recipients and their donors transplanted at our center between 2017 and 2022. Time-zero biopsies were analyzed using AI image analysis software for glomerular density and glomerulosclerosis. One-year patient and allograft survival rates were 96.9% and 85.9%. 5-year survival rate was 74.6%, as opposed to about 41.0% historically reported for patients on dialysis. Delayed Graft Function occurred in 29.7% of cases, with recipient coronary heart disease, BMI-disparities, and prolonged cold ischemia time as major predictors (P < 0.05). Histopathological analysis revealed that the degree of glomerulosclerosis and interstitial fibrosis and tubular atrophy (IFTA) were associated with graft failure in multivariable analyses (P < 0.05). Arteriolosclerosis (arteriolar hyalinosis) correlated with a higher risk for primary non-function (P < 0.05). The number of HLA mismatches was not significantly associated with graft outcome. Including prognostic baseline characteristics as well as histopathological AI analysis into individual allocation decisions during organ-acceptance process might improve allograft survival within the ESP and should prospectively be studied. |
| format | Article |
| id | doaj-art-d53d1b9d7c074387a3896aa390c0413c |
| institution | Kabale University |
| issn | 1432-2277 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Transplant International |
| spelling | doaj-art-d53d1b9d7c074387a3896aa390c0413c2025-08-20T03:55:12ZengFrontiers Media S.A.Transplant International1432-22772025-06-013810.3389/ti.2025.1415314153Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of AllocationTom N. Langer0Tom N. Langer1Thorsten Wiech2Thorsten Wiech3Mercedes Noriega4Sergey Biniaminov5Tobias B. Huber6Tobias B. Huber7Lutz Fischer8Lutz Fischer9Florian Grahammer10Florian Grahammer11Florian Grahammer12Malte A. Kluger13Malte A. Kluger14III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyUniversity Transplant Center (UTC), University Medical Center Hamburg-Eppendorf, Hamburg, GermanyInstitute of Pathology, Nephropathology Section, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyHamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, GermanyInstitute of Pathology, Nephropathology Section, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyHS Analysis GmbH, Karlsruhe, GermanyIII. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyHamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, GermanyUniversity Transplant Center (UTC), University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyIII. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyUniversity Transplant Center (UTC), University Medical Center Hamburg-Eppendorf, Hamburg, GermanyHamburg Center for Kidney Health (HCKH), University Medical Center Hamburg-Eppendorf, Hamburg, GermanyIII. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyUniversity Transplant Center (UTC), University Medical Center Hamburg-Eppendorf, Hamburg, GermanyTo address the shortage of organs for kidney transplantation, the Eurotransplant Senior Program (ESP) was established to enhance kidney allocation from elderly donors. This study aimed to evaluate post-transplant outcomes of deceased donor grafts and identify prognostic factors within the ESP population. We therefore analyzed patient data from 64 ESP recipients and their donors transplanted at our center between 2017 and 2022. Time-zero biopsies were analyzed using AI image analysis software for glomerular density and glomerulosclerosis. One-year patient and allograft survival rates were 96.9% and 85.9%. 5-year survival rate was 74.6%, as opposed to about 41.0% historically reported for patients on dialysis. Delayed Graft Function occurred in 29.7% of cases, with recipient coronary heart disease, BMI-disparities, and prolonged cold ischemia time as major predictors (P < 0.05). Histopathological analysis revealed that the degree of glomerulosclerosis and interstitial fibrosis and tubular atrophy (IFTA) were associated with graft failure in multivariable analyses (P < 0.05). Arteriolosclerosis (arteriolar hyalinosis) correlated with a higher risk for primary non-function (P < 0.05). The number of HLA mismatches was not significantly associated with graft outcome. Including prognostic baseline characteristics as well as histopathological AI analysis into individual allocation decisions during organ-acceptance process might improve allograft survival within the ESP and should prospectively be studied.https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14153/fullkidney transplantationelderlyESP European Senior ProgramAI histopathologymachine learning |
| spellingShingle | Tom N. Langer Tom N. Langer Thorsten Wiech Thorsten Wiech Mercedes Noriega Sergey Biniaminov Tobias B. Huber Tobias B. Huber Lutz Fischer Lutz Fischer Florian Grahammer Florian Grahammer Florian Grahammer Malte A. Kluger Malte A. Kluger Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation Transplant International kidney transplantation elderly ESP European Senior Program AI histopathology machine learning |
| title | Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation |
| title_full | Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation |
| title_fullStr | Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation |
| title_full_unstemmed | Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation |
| title_short | Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation |
| title_sort | clinical and histopathological determinants for kidney allograft survival in the eurotransplant senior program esp at the time of allocation |
| topic | kidney transplantation elderly ESP European Senior Program AI histopathology machine learning |
| url | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14153/full |
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