Kidney Transplantation From Elderly Donor

Area of Science:

• Nephrology
• Transplantation Immunology
• Geriatric Medicine

Background:

• Increasing organ donor shortage necessitates utilizing organs from older donors.
• Acceptance of elderly living-kidney donors is debated due to potential comorbidities and surgical risks.

Purpose of the Study:

• To evaluate graft function and patient survival in kidney transplant recipients receiving organs from donors aged 65 years or older.
• Compare outcomes between recipients of older donor kidneys and younger donor kidneys.

Main Methods:

• Retrospective comparison of 294 patients receiving grafts from donors ≥ 65 years old versus 2339 patients receiving grafts from donors < 65 years old.
• Data collected from December 2008 to December 2013.
• Kaplan-Meier survival estimator and multivariate analysis were used for survival analysis.

Main Results:

• No significant differences in sex, dialysis time, or cold ischemia time between groups.
• Patient survival at 1, 2, and 3 years was comparable, though slightly lower in the older donor group (91.1%, 89.1%, 88.5% vs. 96.7%, 95.9%, 95.0%).
• Graft survival rates at 1, 2, and 3 years were similar (97.6%, 96.4%, 94.1% vs. 97.5%, 96.8%, 95.2%). Donor age, time on dialysis, HLA-DR mismatches, and delayed graft function were associated with patient and graft survival.

Conclusions:

• Utilizing kidneys from donors over 65 can increase renal transplantation rates by 15-20 per million population.
• Good graft and patient survival rates are achievable with proper macroscopic and microscopic evaluation protocols for expanded criteria organs.
• This approach expands the donor pool while maintaining acceptable transplant outcomes.