title: Older living donors provide excellent quality kidneys: a single center experience (older living donors).
abstract: BACKGROUND
  The role of advanced age live donors remains controversial because of decline in glomerular filtration rate and perceived increased risks of perioperative complications.
  
  
  METHODS
  A retrospective review of all live donor transplants performed from January 2000 to December 2003.
  
  
  RESULTS
  Seventy-eight live donor transplants were performed during the period of review, 47 (60.3%) female and 31 (39.7%) male. Twenty-two (28.2%) of the donors were >50 yr old, 15 (68%) female and seven (32%) male. Living related donation was performed in 56 (74.4%) and unrelated in 20 (35.6%). Laparoscopic nephrectomy was performed in 29 (37.2%) and open nephrectomy in 49 (62.8%). More donors >50 underwent laparoscopic nephrectomy, 13 of 22 (59.1%) vs. 16 of 56 (28.6%). Overall patient and graft survival at 1 yr are 97 and 97%. One-year patient and graft survival is 100% vs. 96% and 100% vs. 96% in the older vs. young donors. Rejection occurred in nine of 78 (11.5%), but was not different between groups. Older donors had a reduced creatinine clearance 107.5 +/- 3.4 vs. 124.2 +/- 3.1 mL/min (p = 0.002) and a reduced clearance normalized for body surface area 60.6 +/- 3.6 mL/(min m2) vs. 70.2 +/- 2.6 mL/(min m2) (p = 0.045). Recipient serum creatinine was higher on postoperative day 1 in the older donor group 5.4 mg/dL vs. 4.4 mg/dL (p = 0.009). There was no difference in recipient serum creatinine at postoperative day 7, 30, 90, 180, 365 and 730. Donor serum creatinine was not different between groups on postoperative days 1, 7 and 30 but was higher in group 1 vs. group 2 on postoperative day 365, 1.26 +/- 0.26 mg/dL vs. 1.01 +/- 0.18 mg/dL (p = 0.020).
  
  
  CONCLUSIONS
  Despite a reduced initial creatinine clearance, renal function is comparable in recipients of both young and old donor kidneys. Older donors had a slightly reduced serum creatinine 1 yr post-donation that warrants additional follow-up to determine if the observations continue. The introduction of laparoscopic nephrectomy may provide additional incentive for older donors to present for live donor nephrectomy.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. srjohnso@bidmc.harvard.edu
authors.forename: Scott R
authors.initials: SR
authors.lastname: Johnson
authors.forename: Khalid
authors.initials: K
authors.lastname: Khwaja
authors.forename: Martha
authors.initials: M
authors.lastname: Pavlakis
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Monaco
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000502:physiology*; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000379:methods
chemical_list: D003404:Creatinine