Renal Transplantation from Elderly Living Donors

Abstract

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.

Preoperative Fasting Protects against Renal Ischemia-Reperfusion Injury in Aged and Overweight Mice

“…Although extended criteria donors are getting more and more accepted as an alternative for optimal donors, the outcome after transplantation of an ECD kidney is worse, with higher risks of DGF, acute rejection and graft failure [25] . Since age is a factor that cannot be influenced, reducing the consequences of ischemia is all the more warranted.…”

The Oxidative and Inflammatory State in Patients with Acute Renal Graft Dysfunction Treated with Tacrolimus

“…Donors to the AGD group were significantly older (42.54 ± 11.45 years); and although they were found in a state of perfect health, age could be an independent factor in the appearance of AGD. In this regard, it has been previously reported that the acceptable age of live kidney donors continues to be controversial due to the higher incidence of comorbidities and greater risk of postoperative complications [21, 22]. …”

Tissue donation and transplantation program in Sri Lanka : a medico-legal point of view

“…Transplantation of liver from the individuals above the age of 55 years [14][15][16][17] or renal transplants from individuals more than 65 years have shown a higher failure rate than donations from younger individuals. 18,19,20 It has been reported that with increasing age, the number of organs discarded increases. 21 Harvesting good quality organs from cadavers under the prescribed manner according to the law of the country helps to save valuable human lives.…”