Living Kidney Donors: Impact of Age on Long-Term Safety

Abstract

The safety of older live kidney donors, especially the decline in glomerular filtration rate (GFR) after donation, has been debated. In this study we evaluated long-term renal outcome in older live kidney donors. From 1994 to 2006 follow-up data of 539 consecutive live kidney donations were prospectively collected, during yearly visits to the outpatient clinic. Donors were categorized into two groups, based on age: <60 (n = 422) and ≥60 (n = 117). Elderly had lower GFR predonation (80 vs. 96 mL/min respectively, p < 0.001). During median follow-up of 5.5 years, maximum decline in eGFR was 38% ± 9% and the percentage maximum decline was not different in both groups. On long-term follow-up, significantly more elderly had an eGFR <60 mL/min (131 (80%) vs. 94 (31%), p < 0.001). However, renal function was stable and no eGFR of less than 30 mL/min was seen. In multivariate analysis higher body mass index (HR 1.09, 95%CI 1.03-1.14) and more HLA mismatches (HR 1.17, 95%CI 1.03-1.34) were significantly correlated with worse graft survival. Donor age did not influence graft survival. After kidney donation decline in eGFR is similar in younger and older donors. As kidney function does not progressively decline, live kidney donation by elderly is considered safe.

The Natural History of Residual Renal Function in Transplant Donors

“…Renal functional reserve measured in the same patients before and after kidney donation older donors and found that a greater proportion have GFRs below 60 ml/min compared with younger donors, although GFRs appear to remain stable over time. 11,15 Similarly, GFRs tend to be lower in obese donors, especially those with microalbuminuria (which may reflect hyperfiltration injury), but effect on long-term outcomes is not yet clear. 4,11,16 Pregnancy induces a temporary state of renal hyperperfusion and hyperfiltration.…”

Effect of donor age and parent-to-child transplant on living-related donor kidney transplantation: a single center's experience of 236 cases

“…The high proportion of parental donors raises the question as to whether the outcome of kidney transplant from older living donors is comparable to that from younger living donors and whether living kidney donation has a long-term impact on transplant recipient survival. 4,5 A retrospective study of 117 living donors in China found that the 5-year survival rate for transplant recipients from older living donors (!50 years) was comparable to that of younger living donors. 6 However, the number of older donors in the study was very limited (n ¼ 23) and there were no data on the impact of the parent-child transplant on the survival of the recipient.…”

Evaluation of Potential Living Kidney Donors

“…Donation from well selected older donors (>60 years old) appears to be safe and has good short and long term outcomes. Well selected older donors have no difference in perioperative outcomes when compared to younger donors [17,18].…”