Recipients of kidneys from living donors aged 60 years or older have worse graft and patient survival compared with those who receive younger living donor kidneys, investigators reported at the 2022 American Transplant Congress.
In the 2010-2020 Scientific Registry of Transplant Recipients, 12,455 living donors were aged 50-60 years, 5072 were aged 60-70 years, and 398 were older than 70 years. Half of living donors older than 70 years donated their kidneys to recipients of the same age group.
Recipients of older kidneys had significantly higher mortality risk that increased for each 10-year increment in living donor age, Adam Bregman, MD, MBA, of the University of Minnesota in Minneapolis reported on behalf of his team. In a multivariable model, recipients of kidneys from living donors older than 70 years and aged 60-70 years had 1.9- and 1.3-fold increased risk for early mortality, respectively, compared with recipients of kidneys from living donors aged 50-60 years.
Death-censored graft loss at 5 years was 1.3- and 2.7-fold higher for kidney recipients with living donors aged 60-70 years and older than 70 years, respectively, compared with aged 50-60 years.
Recipients of living donor kidneys older vs younger than 70 years had a higher rate of delayed graft function and lower estimated glomerular filtration rates (eGFR) at 12 months, Dr Bregman reported.
The investigators adjusted models for donor eGFR, hypertension, biological relationship to recipient, cigarette use, ethnicity, and sex. They also adjusted for recipient age, transplant indication, HLA matching, immunosuppressive regimen, transplant year, payer type, and peak panel reactive antibodies.
“Further studies are needed to better understand the best use of advanced age [living donor] kidneys,” Dr Bregman’s team concluded in a study abstract. “Providers should balance the risk between waitlist mortality and burden of dialysis before declining a kidney from an older [living donor].”
Bregman AP, Spong R, El-Rifai R, Swanson K, Jackson S, Riad S. Older living donor kidneys are associated with worse recipient and graft survival compared to younger donors. Presented at: ATC 2022; June 4-8, 2022, Boston, Massachusetts. Abstract 1042.