title: Expanding the donor pool:  living donor nephrectomy in the elderly and the overweight.
abstract: BACKGROUND
  Increasing demand for donor kidneys, in parallel with trends toward more elderly and obese populations, make it important to continuously review donor pool inclusion criteria. Acceptance of elderly and obese living donors remains controversial, with a higher incidence of comorbidity and the greater risk of postoperative complications sighted as reasons for caution. Drawing on our center's experience, we aim to determine whether older age and obesity are in fact associated with greater perioperative risk, and longer term complications in donors undergoing nephrectomy.
  
  
  METHODS
  Three hundred eighty-three living donor nephrectomies conducted at one of the United Kingdom's largest transplant units over the last 5 years were stratified into groups according to age and body mass index. Perioperative endpoints and postdonation follow-up data collected at 6-to-12-monthly intervals were analyzed and compared.
  
  
  RESULTS
  No significant differences in operative parameters, including operative time and estimated blood loss, were reported between groups. Rates of early postoperative complications were not significantly different, although subgroup analysis showed a higher incidence of respiratory complications at the extremes of obesity (body mass index ≥ 40 kg/m²). On follow-up, renal function parameters showed significant change postnephrectomy, but between-group variation was not significant. Mortality and major complication rates were comparably low in all groups of study.
  
  
  CONCLUSIONS
  In our unit's experience, nephrectomy in selected donors who may otherwise have been precluded from participation on account of their age or weight, is feasible and associated with perioperative and longer term outcomes comparable with their younger nonobese counterparts. It provides a basis for informed consent of "extended criteria" donors.
authors.affiliation: Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine, London, United Kingdom.
authors.forename: Benjamin
authors.initials: B
authors.lastname: O'Brien
authors.forename: Sotiris
authors.initials: S
authors.lastname: Mastoridis
authors.forename: Atika
authors.initials: A
authors.lastname: Sabharwal
authors.forename: Nadey
authors.initials: N
authors.lastname: Hakim
authors.forename: David
authors.initials: D
authors.lastname: Taube
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papalois
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D046148:Donor Selection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality; D009765:Obesity; D017063:Outcome Assessment, Health Care; D050177:Overweight; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies