Overview

• Researchers applied a target trial emulation framework to two decades of ERA registry data covering over 64,000 adult dialysis patients across five European regions.
• Transplants using standard-criteria donor kidneys yielded consistent five-year survival benefits across virtually all age and comorbidity groups.
• For recipients aged 75 and older receiving expanded-criteria organs, five-year survival rates of 57–58% barely exceeded the 54% seen in patients remaining on dialysis.
• Elevated early post-operative mortality among older or high-risk patients was identified as the main factor diminishing long-term transplant advantages.
• The findings point to the need for individualized risk assessments, transparent patient counseling and adjustments to organ allocation policies.