20-year experience with elderly donors in living renal transplantation

Purpose. This study evaluates the impact of living renal donors (LD) aged 60 years and older on graft performance and patient survival in an old-for-young constellation. Patients and Methods. We analyzed 144 consecutive LDs between January 1983 and December 2002 (19 patients 60+/125 controls). Results. Mean donor age in the 60+ group was 63.7 (+/- 2.6) years and 43.7 (+/- 9.0) years for the <60 group. Mean recipient age was 42.4 (+/- 15.2) years versus 32.6 (+/- 15.3) years HLA-A, -B, and DR-mismatches were 3.16 (+/- 1.3) for the 60+ group and 3.13 (+/- 1.7) for the controls (P = NS). Rejection episodes in the first year following LD did not differ (53% versus 33%, P = .25). Mean serum creatinine for 65+ versus <65 after 1, 3, and 12 months was 1.91 +/- 1.2 versus 1.48 +/- 0.85 mg/dL (P = .16), 1.82 +/- 0.89 versus 1.29 +/- 0.35 mg/dL (P < .05) and 1.80 +/- 0.31 versus 1.37 +/- 0.38 mg/dL (P < .05) and mean creatinine clearance at 12 months 62 versus 82 mL/min (P = .06). Censored 1-, 3-, and 5-year graft survival was 100% versus 95% (P = NS), 100% versus 93% (P = NS) and 100% versus 83% (P = NS) with no significant difference in the log-rank test for Kaplan Meier. Conclusion. No impact of donor age was found for graft survival but function of the 65+ kidneys at 3 and 12 months was reduced. Living renal donors 60+ are acceptable for carefully allocated recipients.