title: Living Donor Transplantation: Long-Term Evolution Related to Age Matching.
abstract: The lack of donors is favoring living kidney donor (LKD) transplantation worldwide, quite often beyond the classic age-matching rules. We analysed renal function (RF) at 1 and 5 years in all donor and recipients as well as death-censored graft and patient survival. LKD recipients were divided into 4 subgroups: young recipients-young donors (YR-YD; N = 355), elderly recipients-young donors (ER-YD; N = 13), young recipients-elderly donors (YR-ED; N = 67), and elderly recipients-elderly donors (ER-ED; N = 38). "Elderly" was defined as ≥60 years. RF was better in those who received a young allograft (YR-YD/ER-YD) at any time (P < .001). There was a trend toward higher proteinuria among the recipients of an old allograft (YR-ED/ER-ED) at any time (P = not significant [NS]). However, our population showed low levels of proteinuria and this was not a risk factor for graft failure. Logistic regression model showed that creatinine level at 1 year is a good predictor of graft losses. Graft survival was worse in the allografts from elderly donors (P < .001). Analysing the young recipients, renal survival was inferior in those who received an old kidney (YR-ED; P < .00005) as well as mortality rates at 14 years (P = .03). The RF of young (N = 295) and elderly donors (N = 98) was optimal with no progression to ESRD or deaths registered during follow-up. In conclusion, young recipients of elderly kidneys pay the price of a worse RF, allograft prognosis, and patient prognosis. The pair YR-ED is a doable option, but we recommend age matching when it is possible.
authors.affiliation: Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain.
authors.forename: E A
authors.initials: EA
authors.lastname: Florit
authors.affiliation: Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain. Electronic address: fdiekman@clinic.ub.es.
authors.forename: F
authors.initials: F
authors.lastname: Diekmann
authors.affiliation: Nephrologie, Charité Campus Mitte, Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Budde
authors.affiliation: Nephrologie, Charité Campus Mitte, Berlin, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Glander
authors.affiliation: Nephrologie, Charité Campus Mitte, Berlin, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Liefeldt
authors.affiliation: Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Nistal
authors.affiliation: Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Oppenheimer
authors.affiliation: Servicio de Nefrología - Clinical Institute of Nephrology and Urology, Hospital Clinic, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Campistol
authors.affiliation: Nephrologie, Charité Campus Mitte, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Brakemeier
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011507:Proteinuria; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous
chemical_list: D003404:Creatinine