Survival benefit of deceased donor kidney transplantation versus continued dialysis: international target trial emulation.

Deceased donor kidney transplantation offers a significant five-year survival benefit over continued dialysis, especially with standard criteria donors across all ages.

• Why it matters: Understanding which patients benefit most from transplantation informs clinical decisions and resource allocation, particularly given varying donor qualities and recipient characteristics.
• What they did: The study used target trial emulation with European registry data from five countries, analyzing 64,036 dialysis patients waitlisted for first-time deceased donor transplants from 2000 to 2019, assessing survival outcomes.
• The result: Standard criteria donor transplants consistently improved five-year survival regardless of age, while the benefit of expanded criteria donor transplants diminished with age, especially in patients over 75, where survival gains were uncertain.