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Living related kidney donors over 60 years old
V Lezaić1, L Djukanović, R Blagojević-Lazić
1Institute of Urology and Nephrology, Department of Nephrology, University Clinical Center, Belgrade, Yugoslavia.
Insights
Kidney transplants from living donors over 60 offer a viable option, but show increased delayed graft function and slower recovery. Long-term survival rates are lower compared to younger donors, necessitating careful consideration.
Area of Science:
- Nephrology
- Transplantation Surgery
- Geriatric Medicine
Background:
- Increasing demand for kidney transplants due to cadaveric organ shortage.
- Living related kidney donation is a growing alternative.
- A significant portion of living donors are over 60 years old.
Purpose of the Study:
- To compare patient and graft survival and graft function in kidney recipients from living donors over 60 versus under 60 years.
- To evaluate the safety and efficacy of using older living kidney donors.
- To identify potential risks and benefits associated with older living donor kidney transplantation.
Main Methods:
- Retrospective analysis of 149 living related kidney transplantations over 6 years.
- Comparison of outcomes between 50 recipients from donors >60 years (mean age 65) and 99 recipients from donors <60 years (mean age 47).
- Assessment of donor nephrectomy, postoperative complications, remnant kidney function, graft function, patient survival, and graft survival.
Main Results:
- No significant differences in donor nephrectomy, postoperative complications, or remnant kidney function.
- Higher incidence of delayed graft function in recipients from older donors.
- Slower improvement in graft function and higher acute/chronic graft failure rates in the first post-transplant year for older donor recipients.
- Significantly lower 5-year patient survival (77% vs 92%) and kidney graft survival in recipients from older donors.
Conclusions:
- Kidney grafts from living donors over 60 years old can be utilized for transplantation.
- Use of older donors requires careful consideration due to increased risks of delayed graft function and poorer long-term outcomes.
- Transplantation from donors over 70 warrants particular caution.
Abstract:
The lack of available cadaveric organs for transplantation has resulted in an increased number of kidney transplants from living donors. During a period of 6 years, 149 kidney transplantations were performed from living related donors in our institute, 33.5% of whom were older than 60 years of age. In this study we examined the survival of patients and grafts as well as the graft function in 50 patients with transplants from donors over 60 years (mean age 65 years) as compared with those of 99 patients with transplants from donors younger than 60 years (mean age 47 years). There were no significant differences in the course of donor nephrectomy, postoperative complications, or remnant kidney function. However, delayed graft function occurred more frequently in recipients of transplants from older donors. Improvement in graft function was also slower in recipients of kidneys from older donors, with significant differences in serum creatinine levels observed during the first 12 months after transplantation. More frequent acute complications and more progressive chronic graft failure, irrespective of the causes, occurred during the 1st post-transplant year in recipients with grafts from older donors. Five-year patient survival (77% vs 92%) and kidney graft survival differed significantly for the same period with worse results for patients receiving grafts from older donors. It may be concluded that kidney grafts from donors older than 60 years -- and especially those older than 70 years -- may be used for living related kidney transplantation, but with precautions.