Renal transplantation from elderly living donors

Area of Science:

• Nephrology
• Transplantation Surgery
• Geriatric Medicine

Background:

• Acceptance of elderly living kidney donors is debated due to potential comorbidity and postoperative risks.
• A significant increase in living kidney donor transplants has been observed, with a notable rise in donors over 60 years old.

Purpose of the Study:

• To review English-language publications from 2000-2013 on renal transplantation from elderly living donors.
• To identify trends, effects of donation, and outcomes associated with elderly living kidney donors.

Main Methods:

• Systematic review of English-language publications.
• Analysis of trends in living kidney donor transplants, focusing on age demographics.
• Evaluation of donor outcomes (kidney function, established renal failure, hypertension) and recipient outcomes (graft function, rejection, failure).

Main Results:

• Living kidney donor transplants increased by 50% in the last decade, with a disproportionate rise in donors >60 years.
• No accelerated loss of kidney function was observed in elderly donors; incidence of established renal failure and hypertension is similar to the general population.
• Transplants from living donors >65 years showed significantly higher risks of delayed graft function, acute rejection, and graft failure compared to younger donors.

Conclusions:

• Elderly living kidney donors (>60 years) generally experience similar kidney function loss and rates of established renal failure/hypertension as the general population.
• Rigorous donor assessment, including predicted glomerular filtration rate, is essential for elderly donors.
• Transplants from older living donors (>65 years) carry increased risks, necessitating careful consideration and further long-term, prospective research.