Kidneys From Older Living Donors Provide Excellent Intermediate-Term Outcomes After Transplantation

Background. Despite the increasing use of older living donors in kidney transplantation, intermediate-term donor and recipient outcomes are poorly characterized. Methods. We retrospectively compared 143 recipients from donors older than 50 years (older) to 319 recipients from donors 50 years or younger (younger). Results. Mean older donor age (years) was 58; younger age was 37 (P<0.001). One-year, three-year, and five-year patient survival was 99.3%, 94.1%, and 91.3% in recipients of older donors and 99.7%, 98.7%, and 95.4% in recipients of younger donors respectively (P=not significant). One-year, three-year, and five-year death-censored graft survival was 99.2%, 95.0%, and 93.7% in older recipients and 99.7%, 96.7%, and 95.4% in younger recipients respectively (P=not significant). Older and younger recipients demonstrated equivalent rates of vascular complications (2.7% vs. 1.2%, P=not significant) and acute rejection (7.7% vs. 9%, P=not significant). Recipients from donors aged 51 to 59 (n=95), 60 to 69 (n=42), and older than 70 years (n=6) had diminished graft function (eGFR=46 +/- 13, 44.9 +/- 16, 32.2 +/- 18.6 mL/min/1.73m(2) at 5 years respectively) compared with younger donor recipients (58.4 +/- 20.0 mL/min/1.73m(2), P<0.001). Older donors had decreased baseline renal function compared with younger donors (eGFR of 82.5 +/- 35.12 and 105.3 +/- 46.7 mL/min/1.73m(2), respectively). No progressive decline in renal function was observed in older donors (3 years after donation). Conclusion. Older living donor kidneys can be transplanted with low perioperative risk without compromising recipient 5-year patient or graft survival or donor renal function. Younger donor kidneys have superior graft function 5 years after transplantation, highlighting the need for appropriate donor/recipient matching.