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The influence of donor age on function of renal allografts from live related donors
N Sumrani1, P Daskalakis, A M Miles
1Department of Surgery, State University of New York Health Science Center, Brooklyn 11203.
Insights
Kidney transplant outcomes are not affected by donor age, but older donors may lead to slightly reduced renal function over time. These findings suggest elderly donors can still be utilized due to organ shortages.
Area of Science:
- Nephrology
- Transplantation Immunology
Background:
- Donor age is a critical factor in kidney transplant success.
- Limited data exists on the long-term impact of older donor age on renal allograft function.
Purpose of the Study:
- To evaluate the effect of donor age on renal allograft outcomes in live related donor kidney transplants.
- To assess the correlation between donor age and graft survival, rejection episodes, and renal function.
Main Methods:
- Retrospective analysis of 169 consecutive cyclosporine-treated live related donor kidney transplants.
- Analysis included assessment of rejection episodes, graft survival rates, and serum creatinine levels.
- Subgroup analysis was performed for HLA identical siblings and HLA mismatched recipients.
Main Results:
- Graft survival and rejection rates were independent of donor age at 1 and 5 years post-transplant.
- Optimal early post-transplant renal function correlated positively with donor age, especially in HLA mismatched male recipients.
- Long-term renal function was inferior but stable in recipients of older donor kidneys (age > 55 years) compared to younger donors.
Conclusions:
- Donor age does not significantly impact renal allograft survival or rejection rates.
- While older donor kidneys may lead to reduced long-term renal function, they should still be considered due to organ scarcity.
- The use of elderly donors (age > 55 years) should not be discouraged given the minimal donor morbidity.
Abstract:
To assess the influence of donor age on renal allograft outcome, we retrospectively analyzed all 169 consecutive cyclosporine-treated live related donor kidney transplants, of whom 40 were HLA identical siblings. All recipients were similar with respect to demographic and immunologic characteristics. Incidence of rejection episodes and graft survival rates at 1 and 5-year posttransplant were independent of donor age. Best renal function, as assessed by the mean of the lowest 3 serum creatinine concentration levels in the first 2 months posttransplant correlated positively with donor age, particularly among HLA mismatched male recipients (r = 0.4, P < 0.002). Short and intermediate term renal function was inferior, but stable in the older donor recipient group when compared to the younger cohort. Mean serum creatinine levels at 5 years in recipients of kidneys from older donors (age > 55 years) was 2.6 mg/dl compared to 1.7 and 1.9 mg/dl in recipients of kidneys from donors between the ages of 18-39 and 40-54 years, respectively (P < 0.001). In view of the universal shortage of organs and the negligible morbidity to the donors, our results should not discourage the use of kidneys from elderly (age > 55 years) donors.