title: Outcomes in kidney transplant recipients from older living donors.
abstract: BACKGROUND
  Previous studies demonstrate that graft survival from older living kidney donors (LD; age>60 years) is worse than younger LD but similar to deceased standard criteria donors (SCD). Limited sample size has precluded more detailed analyses of transplants from older LD.
  
  
  METHODS
  Using the United Network for Organ Sharing database from 1994 to 2012, recipients were categorized by donor status: SCD, expanded criteria donor (ECD), or LD (by donor age: <60, 60-64, 65-69, ≥70 years). Adjusted models, controlling for donor and recipient risk factors, evaluated graft and recipient survivals.
  
  
  RESULTS
  Of 250,827 kidney transplants during the study period, 92,646 were LD kidneys, with 4.5% of these recipients (n=4,186) transplanted with older LD kidneys. The use of LD donors 60 years or older increased significantly from 3.6% in 1994 to 7.4% in 2011. Transplant recipients with older LD kidneys had significantly lower graft and overall survival compared to younger LD recipients. Compared to SCD recipients, graft survival was decreased in recipients with LD 70 years or older, but overall survival was similar. Older LD kidney recipients had better graft and overall survival than ECD recipients.
  
  
  CONCLUSIONS
  As use of older kidney donors increases, overall survival among kidney transplant recipients from older living donors was similar to or better than SCD recipients, better than ECD recipients, but worse than younger LD recipients. With increasing kidney donation from older adults to alleviate profound organ shortages, the use of older kidney donors appears to be an equivalent or beneficial alternative to awaiting deceased donor kidneys.
authors.affiliation: 1 Department of Surgery, Duke University Medical Center, Durham, NC. 2 Duke Clinical Research Institute, Durham, NC. 3 CTI, Clinical Trial and Consulting Services, Raleigh, NC. 4 Division of Abdominal Transplantation, Duke University Medical Center, Durham, NC. 5 Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, NC.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Schechter
authors.forename: William D
authors.initials: WD
authors.lastname: Irish
authors.forename: Kadiyala V
authors.initials: KV
authors.lastname: Ravindra
authors.forename: Deepak S
authors.initials: DS
authors.lastname: Vikraman
authors.forename: Scott L
authors.initials: SL
authors.lastname: Sanoff
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ellis
authors.forename: Debra L
authors.initials: DL
authors.lastname: Sudan
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult