Older Living Donor Kidneys Superior

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They yield better outcomes than deceased-donor kidneys in the elderly.

Kidneys from older living donors (OLDs) may be an important option for elderly renal transplant candidates, according to a study of 23,754 kidney-only transplants performed in recipients aged 60 years and older.

Investigators stratified subjects into one of four groups based on donor source: OLDs, who were older than 55 years; younger living donors (YLDs), who were aged 55 years and younger; standard criteria deceased donors (SCDs), and expanded criteria deceased donors (ECDs).

Overall, YLD and OLD transplants yielded better outcomes than SCD and ECD transplants. OLD transplants were associated with slightly lower overall four-year graft and patient survival rates compared with YLD transplants (77.7% vs. 80.7% and 82.4% vs. 84.2%, respectively), researchers reported in the American Journal of Kidney Diseases (2008;52:541-552).

After adjusting for potential confounders, recipients of kidneys from OLDs aged 55-64 had graft and patient survival rates (78.2% and 82.7%, respectively) that were not significantly different from those of YLD recipients. Recipients of transplants from OLDs aged 65 and older had a graft survival rate (75.4%) comparable to that of SCD transplant recipients and they had graft and patient survival rates that were superior to those of ECD transplant recipients, whose rates were 57.1% and 67.5%, respectively. In multivariate analysis, ECD transplantations were associated with a 2.36 times greater risk of graft loss and a 2.8 times greater risk of death when compared with OLD transplantations.

Renal transplant candidates over age 60 are common on transplant waitlists and their numbers are growing, observed lead author Jagbir Gill, MD, assistant professor of medicine at the University of British Columbia and transplant nephrologist at St. Paul's Hospital in Vancouver. Under newer proposed organ allocation strategies that take recipient age into consideration, elderly transplant candidates may have a long wait for a kidney, effectively leaving ECD and living donor transplantation as the most timely options for elderly patients waiting for a transplant, he said.

“Transplants from older living donors do very well, and maybe this could be an option for elderly patients,” Dr. Gill said. “It's important to note, however, that older living donors are probably already considered by many transplant centers, but we now have data to support this practice more widely.”
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