Increased Use, Good Outcomes of Living Kidney Transplants from Older Donors

Kidney transplants from living donors (LDs) aged 60 or older are increasing, with recipient survival rates at least as good as those after deceased standard donor criteria (SDC) transplantation, reports a study in Transplantation.

The researchers analyzed United Network for Organ Sharing data from 1994 to 2012, focusing on trends in the use of older LD kidneys and their outcomes. Of the total 250,827 transplants, 92,646 were from LDs.

Overall, 4.5 percent of recipients of LD transplants received organs from donors aged 60 or older. The percentage of older LD transplants increased from 3.6 percent in 1994 to 7.4 percent in 2011; most of the growth was among donors aged 60–69. Older LD kidneys were associated with lower graft and overall survival compared with younger LD kidneys.

Graft survival was also lower with LD kidneys from donors aged 70 or older, compared with deceased SCD transplants. However, overall survival was similar between these groups. Both graft and overall survival were higher for older LD kidneys compared with expanded criteria donor (ECD) transplants.

As the use of older LD kidneys increases, questions remain about their safety and efficacy. The new study shows that although younger LD transplants still have the best outcomes, older LD kidneys yield overall survival similar to that with deceased SCD transplants and better than with ECD kidneys. The investigators conclude, “[T]he comparable long-term outcomes of kidneys from older living donors compared to SCD or ECD kidneys with the short-term advantages of avoiding dialysis promote the expanded use of this resource” [Englum BR, et al. Outcomes in kidney transplant recipients from older living donors. Transplantation 2015; 99:309–315].