Accepting Kidneys from Older Living Donors: Impact on Transplant Recipient Outcomes

Young, Ann; Kim, S. J.; Speechley, Mark; Huang, Anjie; Knoll, Greg; Prasad, G. V. Ramesh; Treleaven, Darin; Diamant, Michael J.; Garg, Amit X.

doi:10.1111/j.1600-6143.2011.03442.x

Cited by 56 publications

(46 citation statements)

References 18 publications

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“…However, the included studies were small and were from single centers, and there was significant heterogeneity between the studies. A recent study from Ontario, Canada, demonstrated similar allograft survival between recipients of older living donor kidneys aged $60 years and recipients of standard criteria deceased donor kidneys; however, this analysis was limited by relatively short follow-up of 4 years (10).…”

Section: Discussionmentioning

confidence: 88%

Living Donor Age and Kidney Allograft Half-Life

Chang

Gill

Dong

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Living donor paired exchange programs assume that kidneys from living donors are of comparable quality and anticipated longevity. This study determined actual allograft t 1/2 within different recipient age groups (10-year increments) as a function of donor age (5-year increments), and juxtaposed these results against the probabilities of deceased donor transplantation, and exclusion from transplantation (death or removal from the wait-list). Results With the exception of recipients aged 18-39 years, who had the best outcomes with donors aged 18-39 years, living donor age between 18 and 64 years had minimal effect on allograft t 1/2 (difference of 1-2 years with no graded association). The probability of deceased donor transplantation after 3 years of wait-listing ranged from 21% to 66% by blood type and level of sensitization, whereas the probability of being excluded from transplantation ranged from 6% to 27% by age, race, and primary renal disease.Conclusions With the exception of recipients aged 18-39 years, living donor age between 18 and 64 years has minimal effect on allograft survival.

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Section: Discussionmentioning

confidence: 88%

Living Donor Age and Kidney Allograft Half-Life

Chang

Gill

Dong

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…By contrast, in this same time period, LKD has increased 2% per year for those aged $50 years. Importantly, older donors do not appear to be at any heightened risk of poor outcomes after donation (52), and LDKT outcomes from older living donors are comparable to receiving a kidney from a deceased standard criteria donor (53). Research is needed to examine the underlying mechanism for the shift in living donor age and whether it persists after implementation of the new kidney allocation system.…”

Section: Agementioning

confidence: 99%

Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

105

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Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.

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“…1 Kidney paired donation (KPD) is one option increasingly utilized to increase living donor (LD) rates to allow ABO incompatible or highly sensitized but otherwise willing and appropriate kidney donor-recipient pairs to exchange their kidneys.…”

Section: Introductionmentioning

confidence: 99%

Does donor–recipient age difference matter in outcome of kidney transplantation? Implications for kidney paired donation

et al. 2013

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Background: Kidney paired donation (KPD) is a rapidly growing modality for facilitating living donor kidney transplantation (LDKTx) for patients who are incompatible with their healthy, willing and living donor. The impact of donor-recipient age difference on long and short-term graft and patient survivals in LDKTx is still uncertain. Methods: A total of 1502 LDKTx recipients who received regular follow-up in our center from 1999 to 2012 were studied. Donor-recipient age difference was divided into subgroups (donor-recipient 0À10, 11-20, 0-20, 21-30, 31-40, and 21-40 years). Outcome measures included death censored graft, patient survival and acute rejection rate. Results: The 1-, 5-, 10-year patient survival of the donor-recipient age difference 20 years group showed no difference compared with the age difference 420 years group (94.5%, 83.2%, 71.9% and 95.2%, 86%, 77.8%, p ¼ 0.053). The 1-, 5-, 10-year graft survival of the donor-recipient age difference 20 years group showed no difference compared with the age difference420 years group (94.6%, 81.6%, 72.1% and 94%, 80%, 72.2%, p ¼ 0.989). The rejection were also similar (17.5% vs. 16.5%, p40.05). There was no statistically significant difference in graft survival and acute rejection rate in all subgroups. Conclusions: Older donors (usually within families) are not associated with worse outcome is reassuring. KPD should not be prohibited due to high donor-recipient age difference, when size of donor pool is small as in single center KPD program.

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Accepting Kidneys from Older Living Donors: Impact on Transplant Recipient Outcomes

Cited by 56 publications

References 18 publications

Living Donor Age and Kidney Allograft Half-Life

Living Donor Age and Kidney Allograft Half-Life

Living Donor Kidney Transplantation

Does donor–recipient age difference matter in outcome of kidney transplantation? Implications for kidney paired donation

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