{"id":"b254d3440bd9","type":"article","url":"https://hartvaat.nl/2026/09/18/niertransplantatie-met-standaardcriteria-donor-verhoogt-overleving-ten-opzichte-/","title":"Niertransplantatie met standaardcriteria-donor verhoogt overleving ten opzichte van dialyse","title_en":"Survival benefit of deceased donor kidney transplantation versus continued dialysis: international target trial emulation.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"BMJ (Clinical research ed.)","doi":"10.1136/bmj-2026-100624","source_url":"https://doi.org/10.1136/bmj-2026-100624","authors":["Rachel Hellemans","Nicholas C Chesnaye","Anneke Kramer","Edouard L Fu","Miha Arnol","Anders Åsberg","Claus Bistrup","Pietro Manuel Ferraro","Kristian Heldal","Jaakko Helve","Camille Legeai","James Medcalf","Dorothea Nitsch","Laia Oliveras","María José Pérez-Sáez","Belén Ponte","Emilie Savoye","Mårten Segelmark","Shaminie Shanmugaranjan","Søren S Sørensen","Roser Torra","Alberto Ortiz","Kitty J Jager","Vianda S Stel"],"significance":8,"published":"2026-09-27","source_date":"2026-09-18","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"An international target trial emulation involving 64,036 patients on dialysis demonstrates that deceased donor kidney transplantation using standard criteria donors (SCD) significantly improves five-year survival across all age groups and comorbidity profiles. However, the survival advantage diminishes with expanding donor criteria and increasing recipient age; among 75-year-olds receiving an expanded criteria donor/donation after circulatory death (ECD/DCD) graft, five-year survival was not significantly different from continued dialysis (59% vs 55%), accompanied by a threefold higher early post-transplant mortality. These findings reinforce SCD transplantation as the standard of care while highlighting the need for individualized risk-benefit assessment in older patients considering ECD/DCD grafts.","created":"2026-09-20T01:38:24Z","updated":"2026-09-20T01:38:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een internationale target trial-emulatie met 64.036 dialysepatiënten toont aan dat een donorniertransplantatie met standaardcriteria-donor de vijfjaarsoverleving significant verhoogt, ongeacht leeftijd of comorbiditeit. Bij transplantaties met uitgebreide donorcriteria (ECD) daalt dit voordeel echter met de leeftijd; bij patiënten van 75 jaar met een ECD-donor na circulatoire dood (DCD) is er geen overlevingsvoordeel meer ten opzichte van doorzetten van dialyse, met een drievoudig hoger vroeg postoperatief sterftecijfer. Deze bevindingen ondersteunen het gebruik van standaardcriteria-donoren voor brede groepen, maar waarschuwen voor zorgvuldige afweging van donor- en patiëntkenmerken bij oudere patiënten.","abstract_original":"OBJECTIVE: To quantify the survival benefit of deceased donor kidney transplantation versus continued dialysis according to patients' characteristics (age, diabetes, cardiovascular disease), donor quality (standard criteria donor or expanded criteria donor) and donor retrieval type (donation after brain death or donation after circulatory death). DESIGN: Target trial emulation. SETTING: European Renal Association Registry data from five countries or regions: Catalonia (Spain), Denmark, France, Norway, and the UK. PARTICIPANTS: Patients aged ≥20 years receiving dialysis and waitlisted for a first deceased donor kidney-only transplant between 2000 and 2019. MAIN OUTCOME MEASURES: Five year patient survival following deceased donor kidney transplantation versus continued dialysis within monthly sequential trials. Flexible parametric spline models estimated adjusted five year patient survival across recipient age. RESULTS: Of 64 036 waitlisted patients receiving dialysis, 39 244 received a deceased donor kidney transplant: 16 897 (43.1%) from a standard criteria donor/donation after brain death donor, 4324 (11.0%) from a standard criteria donor/donation after circulatory death donor, 14 799 (37.7%) from an expanded criteria donor/donation after brain death donor, and 3224 (8.2%) from an expanded criteria donor/donation after circulatory death donor. Standard criteria donor/donation after brain death and standard criteria donor/donation after circulatory death transplantation showed higher estimated five year survival compared with continued dialysis regardless of recipient age. However, the survival benefit associated with expanded criteria donor/donation after brain death transplantation and, particularly, expanded criteria donor/donation after circulatory death transplantation decreased with increasing recipient age, albeit with greater statistical uncertainty among older patients. For example, among 75 year olds, estimated five year survival following expanded criteria donor/donation after circulatory death transplantation did not differ significantly from that with continued dialysis (59% (95% confidence interval 51% to 66%) versus 55% (54% to 55%); hazard ratio 0.97, 95% confidence interval 0.70 to 1.33), irrespective of diabetes or cardiovascular disease status. This group had a threefold higher early post-transplant mortality than those continuing dialysis. CONCLUSIONS: Standard criteria donor kidney transplantation was consistently associated with a survival benefit compared with continued dialysis. By contrast, the survival benefit associated with expanded criteria donor transplantation declined with increasing recipient age, particularly for expanded criteria donor/donation after circulatory death transplantation, such that the oldest recipients had a smaller and more statistically uncertain estimated survival advantage over continued dialysis."}