Long-Term Outcomes Across Age and Risk Profiles in a Caucasian Living Kidney Donor Cohort

Area of Science:

• Nephrology
• Transplant Surgery
• Geriatric Medicine

Background:

• Living kidney donation is crucial for recipient outcomes.
• Long-term data on older and medically complex living kidney donors are limited.
• Understanding donor risk factors is essential for safe donation practices.

Purpose of the Study:

• To evaluate long-term kidney function and cardiovascular outcomes in living kidney donors stratified by age.
• To identify predictors of renal impairment after living kidney donation.
• To assess the impact of age, comorbidities, and baseline renal function on donor outcomes.

Main Methods:

• Prospective follow-up of 632 living kidney donors from 1991-2020.
• Donors stratified into age groups: <40, 40-60, and >60 years.
• Primary outcomes: ≥50% estimated Glomerular Filtration Rate (eGFR) decline and eGFR <45 mL/min/1.73 m²; secondary outcomes included major adverse cardiovascular events.

Main Results:

• Kidney function (eGFR) declined by 26.0% post-donation, then stabilized.
• Long-term (median 12 years) ≥50% eGFR decline occurred in 4.8% (<40), 5.3% (40-60), and 14.4% (>60) of donors.
• eGFR <45 mL/min/1.73 m² affected 1.2% (<40), 5.3% (40-60), and 20.4% (>60) of donors.
• Age, hypertension, and baseline eGFR independently predicted renal impairment.
• Younger donors with hypertension/obesity had risks comparable to healthy older donors.

Conclusions:

• Living kidney donation is associated with stable long-term kidney function post-donation.
• Donor age is a factor, but baseline renal reserve and comorbidities are more significant drivers of long-term outcomes.
• Risk stratification should consider individual donor health beyond chronological age for safe living kidney donation.