The older living kidney donor: Part of the solution to the organ shortage.
BACKGROUND
Strategies to increase kidney transplantation are urgently needed.


METHODS
We studied all (n = 73,073) first kidney-only transplant recipients in the United States between 1995 and 2003 to determine the incidence and outcomes of living donor transplantation as a function of donor age. Because 90% of living donors were <55 years, we defined older living donors as > or =55 years. Factors associated with transplantation from older living donors and the association of living donor age with allograft function and survival were determined.


RESULTS
Recipients of older age, female gender, white race, and preemptive transplants had higher odds of older living donor transplantation. Older living donor transplantation was more likely from spousal donors rather than blood relatives, and more likely when a husband was the donor. The glomerular filtration rate (GFR) one year after transplantation decreased with increasing donor age (P < 0.001). Graft survival from living donors > or =55 years was 85% and 76% at three and five years (compared to 89% and 82% with living donors <55 years, and 82% and 73% with deceased donors <55 years). In a multivariate model, the risk of graft loss with living donors 55-64 years was similar to that with deceased donors <55 years, while recipients from living donors 65-69 years (HR = 1.3, 95% CI: 1.1-1.7) and >70 years (HR = 1.7, 95% CI: 1.1-2.6) had a higher relative risk of graft loss.


CONCLUSIONS
Outcomes are excellent with living donors <65 years. Expanded use of older living donors may help meet the demand for transplantation.
Gill
John S
JS
Department of Nephrology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. jgill@providencehealth.bc.ca
Gill
Jagbir
J
Rose
Caren
C
Zalunardo
Nadia
N
Landsberg
David
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States