Influence of Cadaver Donor Age on the Success of Kidney Transplants

Hong, Joon Ho; Shirani, Khan Z.; Arshad, Abdul; Parsa, I.; Matas, Arthur; Adamsons, R J; Butt, Khalid M. H.

doi:10.1097/00007890-198112000-00017

Cited by 46 publications

(8 citation statements)

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“…In order to cope with the increased demands the idea of using kidneys from older donors has been an increasingly attractive option [9]. Previous uni-and multivariate analyses have not taken into account age difference, and have found risks associated with donor rather than recipient age [4,9,12,14,21,29,30]. This is the first study to document the benefits of considering the relative ages of donor and recipient, rather than the absolute ages only.…”

Section: Discussionmentioning

confidence: 99%

Donor-recipient age difference?an independent risk factor in cyclosporin-treated renal transplant recipients

et al. 1991

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Whilst HLA matching is routine in renal transplantation the possible benefits of matching donor to recipient age have not been previously explored. The simultaneous effect on graft survival of donor and recipient age was therefore investigated for 274 consecutive first cadaver transplant recipients treated by cyclosporin immunosuppression in two centres. The overall graft survival was 77%, and was not significantly different between the two centres. Individually there was no significant effect of donor or recipient age but taken together, the difference in age significantly affected graft survival (P less than 0.01) regardless of the mode of failure. The 1-year graft survival for all failures was 66.2% when the donor was 5 or more years older. 84.5% when the donor was 5 or more years younger and 71.7% when the donor was within 5 years of the recipient's age. Multivariate analysis, taking into account other variables (HLA matching, dialysis time and type, donor/recipient sex, local/imported kidneys, sensitivity, operation time, total ischaemic time, pre-operative transfusions) indicated that age difference was the single most important variable (P less than 0.01). The only other important covariate risk factor in improving graft survival was HLA-DR matching (P less than 0.05). Donor-recipient age difference is a potentially important recipient selection criterion in cyclosporin-treated renal transplant patients.

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Section: Discussionmentioning

confidence: 99%

Donor-recipient age difference?an independent risk factor in cyclosporin-treated renal transplant recipients

et al. 1991

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“…For cadaveric kidney transplantation, O'Connor et al [15] reported in 1986 that kidney grafts from donors over 55 years of age achieved primary graft function and i-year graft survival comparable to those from younger donors. Hong et al [8] in 1981 and Foster et a1. [5] in 1988, on the other hand, described a significantly lower incidence of immediate function and i-year graft survival in cadaver allografts from donors over 50 years of age.…”

Section: Discussionmentioning

confidence: 97%

Personal experience with the procurement of 132 liver allografts

1989

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Abstract.A single donor surgeon's experience procuring the livers from 132 donors is described. Thirty-seven grafts (28.9%) had hepatic arterial anomalies, 19 (14.4%) of which required arterial reconstruction prior to transplantation. Of the 121 grafts evaluated for early function, 103 grafts (85.2%) functioned well, whereas 14 grafts (11.6%) functioned poorly and 4 grafts (3.3%) failed to function at all. The variables associated with less than optimal function of the graft consisted of donor age (P< 0.05), duration of donor's stay in the intensive care unit (P < 0.005), abnormal graft appearance (P < 0.05), and such recipient problems as vascular thromboses during or immediately following transplantation (P < 0.005). A new preservation fluid, University of Wisconsin solution, allowed safe and longer cold storage of the liver allograft than did Euro-Collins' solution (P < 0.0001). A parameter of liver allograft viability, which is simple and predictive of allograft function prior to the actual transplant procedure, is urgently needed.

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“…This is attributed to reduced nephron mass, senescence, greater susceptibility to ischemic injury, and acute rejection episodes being more prevalent in the elderly. Whereas donor age is a strong determinant of death censored graft survival among recipients of deceased donor kidneys [5], the relationship between living donor age and graft survival is less clear [6, 7]. Kidneys from deceased older donors are more likely to be transplanted into older recipients, and this may potentially confound the impact of donor age on outcome [8].…”

Section: Introductionmentioning

confidence: 99%

“…Acceptance of elderly living donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications [9]. Such a risk to a donor whose benefit is at best psychological may be difficult to justify, as it may stretch the “first do no harm principle” [5–8]. …”

Section: Introductionmentioning

confidence: 99%

Renal Transplantation from Elderly Living Donors

Akoh

Thiyagarajan

2013

Journal of Transplantation

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Acceptance of elderly living kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. This is a review of publications in the English language between 2000 and 2013 about renal transplantation from elderly living donors to determine trends and effects of donation, and the outcomes of such transplantation. The last decade witnessed a 50% increase in living kidney donor transplants, with a disproportionate increase in donors >60 years. There is no accelerated loss of kidney function following donation, and the incidence of established renal failure (ERF) and hypertension among donors is similar to that of the general population. The overall incidence of ERF in living donors is about 0.134 per 1000 years. Elderly donors require rigorous assessment and should have a predicted glomerular filtration rate of at least 37.5 mL/min/1.73 m2 at the age of 80. Though elderly donors had lower glomerular filtration rate before donation, proportionate decline after donation was similar in both young and elderly groups. The risks of delayed graft function, acute rejection, and graft failure in transplants from living donors >65 years are significantly higher than transplants from younger donors. A multicentred, long-term, and prospective database addressing the outcomes of kidneys from elderly living donors is recommended.

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Influence of Cadaver Donor Age on the Success of Kidney Transplants

Cited by 46 publications

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Donor-recipient age difference?an independent risk factor in cyclosporin-treated renal transplant recipients

Donor-recipient age difference?an independent risk factor in cyclosporin-treated renal transplant recipients

Personal experience with the procurement of 132 liver allografts

Renal Transplantation from Elderly Living Donors

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