Living kidney donors ages 70 and older: recipient and donor outcomes.
OBJECTIVE
The profound organ shortage has resulted in longer waiting times and increased mortality for those awaiting kidney transplantation. Consequently, patients are turning to older living donors. It is unclear if an upper age limit for donation should exist, both in terms of recipient and donor outcomes.


METHODS
In the United States, 219 healthy adults aged ≥70 have donated kidneys at 80 of 279 transplant centers. Competing risks models with matched controls were used to study the independent association between older donor age and allograft survival, accounting for the competing risk of recipient mortality as well as other transplant factors.


RESULTS
Among recipients of older live donor allografts, graft loss was significantly higher than matched 50-to 59-year-old live donor allografts (subhazard ratio [SHR] 1.62, 95% confidence interval [CI] 1.16 to 2.28, P = 0.005) but similar to matched nonextended criteria 50-to 59-year-old deceased donor allografts (SHR 1.19, 95% CI 0.87 to 1.63, P = 0.3). Mortality among living kidney donors aged ≥70 was no higher than healthy matched controls drawn from the NHANES-III cohort; in fact, mortality was lower, probably reflecting higher selectivity among older live donors than could be captured in National Health and Nutrition Examination Survey III (NHANES-III; HR 0.37, 95% CI 0.21 to 0.65, P < 0.001).


CONCLUSIONS
These findings support living donation among older adults but highlight the advantages of finding a younger donor, particularly for younger recipients.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Jonathan C
JC
Berger
Abimereki D
AD
Muzaale
Nathan
N
James
Mohammed
M
Hoque
Jacqueline M Garonzik
JM
Wang
Robert A
RA
Montgomery
Allan B
AB
Massie
Erin C
EC
Hall
Dorry L
DL
Segev
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous