The effects of donor age on organ transplants: A review and implications for aging research

Abstract

Despite the considerable amount of data available on the effect of donor age upon the outcomes of organ transplantation, these still represent an underutilized resource in aging research. In this review, we have compiled relevant studies that analyze the effect of donor age in graft and patient survival following liver, kidney, pancreas, heart, lung and cornea transplantation, with the aim of deriving insights into possible differential aging rates between the different organs. Overall, older donor age is associated with worse outcomes for all the organs studied. Nonetheless, the donor age from which the negative effects upon graft or patient survival starts to be significant varies between organs. In kidney transplantation, this age is within the third decade of life while the data for heart transplantation suggest a significant effect starting from donors over age 40. This threshold was less defined in liver transplantation where it ranges between 30 and 50 years. The results for the pancreas are also suggestive of a detrimental effect starting at a donor age of around 40, although these are mainly derived from simultaneous pancreas-kidney transplantation data. In lung transplantation, a clear effect was only seen for donors over 65, with negative effects of donor age upon transplantation outcomes likely beginning after age 50. Corneal transplants appear to be less affected by donor age as the majority of studies were unable to find any effect of donor age during the first few years posttransplantation. Overall, patterns of the effect of donor age in patient and graft survival were observed for several organ types and placed in the context of knowledge on aging.

Does donor‐recipient age difference matter in outcome of heart transplantation?

“…Studies with patients and animal models of kidney transplantation have reported a stronger immune response in recipients with older donors with an elevated occurrence of acute rejection episodes . To the best of our knowledge, we have shown for the first time, similar results in heart transplanted patients.…”

Influence of donors’ cigarette smoking on recipients’ postoperative survival and complications after simultaneous pancreas-kidney transplantation

“…The signi cant differences in overall, graft and kidney survival found in the Kaplan-Meier analysis were mainly related to donors' age, which has been con rmed as a risk factor for death [20,21]. However, only a small difference between the smoking and non-smoking donors was found when the donors' age was analyzed by subgroups.…”

Assessing the Outcome of Adult Kidney Transplantation from a Deceased Expanded Criteria Donor: A Descriptive Study

“…Studies suggest that kidneys from donors over the age of 60 may have suboptimal graft survival, with a three-year graft survival being only 58% [7] while a recent study suggests that the new age of worsening 1 1 1 survival rate has increased to 70 years of age in the same group [8]. Therefore, the donor age is thought to be the most significant factor that can negatively impact graft survival [9]. The kidney profile donor index (KDPI) score has been used to assess the risk of graft loss of any given donor compared to the median population of donors using 10 donor-specific criteria including age, sex, height, weight, history, and duration of hypertension and diabetes, hepatitis C virus (HCV) status, donation after cardiac death (DCD) status, and donor cause of death.…”