Outcomes of kidney transplantation from older living donors to older recipients

Background: More than half the newly wait-listed patients for kidney transplantation in 2005 were older than 50 years, and 13% were older than 65 years. As waiting times for a deceased donor kidney increase, these older candidates are disadvantaged by rapidly deteriorating health, often resulting in death or removal from the wait list before transplantation. Study Design: An observational cohort study was conducted using data from the Organ Procurement Transplant Network/United Network for Organ Sharing. Setting & Participants: All adult kidney-only transplantations performed in recipients 60 years and older from 1996 to 2005 were included. Predictor: The recipient cohort was stratified into 4 groups based on donor source: older living donor (OLD: living donor age > 55 years), younger living donor (YLD: living donor age <= 55 years), standard criteria deceased donor (SCD), and expanded criteria deceased donor (ECD). Outcomes & Measurements: Early posttransplantation outcomes, graft survival, patient survival, renal function 1 year posttransplantation, and relative risk of graft loss and patient death were compared. Results: Of 23,754 kidney transplantations performed in recipients 60 years and older, 7,006 were living donor transplantations (1, 133 were > 55 years [OLD] and 5,873 were : 55 years [YLD]), 12,197 from SCDs, and 4,551 from ECDs. Early posttransplantation outcomes were best in YLD transplantations, followed by SCD and OLD transplantations. OLD transplantations were associated with inferior 3-year graft survival rates (85.7%), but similar 3-year patient survival rates (88.4%) compared with YLD (3-year graft survival, 83.4%; patient survival, 87.4%) and had superior graft survival compared with all deceased donor options. Compared with OLD transplantations, ECD transplantations were associated with a greater risk of graft loss (hazard ratio, 2.36; 95% confidence interval, 1.18 to 4.74). Limitations: Observational retrospective studies using registry data are subject to inherent limitations, including the possibility of selection bias. Conclusions: With superior graft and patient survival in recipients of transplants from OLDs compared with SCDs and ECDs, OLDs may be an important option for elderly transplantation candidates and should be considered for older patients with a willing and suitable older donor.