Living Donor Age and Kidney Allograft Half-Life

Abstract

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.

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

“…They concluded that LD who are up to 30 years older than their recipients, provide kidneys of excellent quality. 2 A recent study by John Gill et al 11 analyzed the survival of kidneys from donors of different age groups that were transplanted into recipients of different age groups. Their study included data from all adult LDKTx recipients that were performed in the United States from 1988 to 2003.…”

“…They concluded that with the exception of recipients aged 18-39 years; LD age between 18 and 64 years has minimal effect on allograft survival. 11 Lee et al 12 evaluated the impact of donors older than recipients on transplant outcomes and showed that the donorrecipient age difference ! 20 years (n ¼ 75) group showed no difference in 5-year patient survival and death censored graft survival rates compared with donor-recipient age differences 520 years (n ¼ 25), which also showed a 65% 10-year-graft survival rate.…”

Living Donor Kidney Transplantation

“…A study that examined the half-life of LDKTs as a function of both recipient age and living donor age showed that LDKT recipients of all age groups had longer functioning grafts than similar patients who received standard criteria donor deceased donor transplants, unless the living donor kidney came from someone age $65 years old (4). The long-term graft half-life of LDKTs in the older recipient population was equivalent to that of standard criteria donor transplants (4). Another study showed that LDKTs from donors over 70 years old were equivalent to DDKTs from donors in their 50s (5).…”

Equipoise: Ethical, Scientific, and Clinical Trial Design Considerations for Compatible Pair Participation in Kidney Exchange Programs

“…A second approach may include providing a kidney from a younger donor. For clinical implementation, we would propose that a reduction in donor age of at least 15 years, which has been demonstrated to decrease age related risk of renal allograft failure across various recipient groups (21). A third potential approach for mitigating risk would include providing a kidney with a higher GFR.…”