The advantage of live-donor kidney transplantation in older recipients

Although renal transplantation confers a survival advantage over maintenance dialysis in patients with end-stage renal disease, many factors can attenuate this survival advantage over the long term. Among the most important negative influences on outcomes are older donor age, extended time on the transplant waiting list, and use of organs from deceased donors. Whether it is better to avoid prolonged waiting times for a standard criteria donor kidney by transplanting an organ from an older living donor is a clinically important question. In their analysis, Gill and colleagues have addressed this question for older transplant recipients. The investigators' primary finding is that survival after transplantation from an older living donor is at least equivalent to that after transplantation from a younger deceased donor (i.e. a standard criteria donor) and superior to that observed following transplantation from expanded criteria donors. Reasons that prevent a straightforward clinical application of such findings are discussed in this commentary.