Korean J Transplant.  2021 Dec;35(4):238-246. 10.4285/kjt.21.0020.

Recipient efficacy and safety of kidney transplantation from older living donor: consideration for using older kidney as a solution to the shortage of organs

• Song JY
• Lee KW
• Kim K
• Kim KD
• Yang J
• Kwon JE
• Lee O
• Park JB

• KMID: 2523673
• DOI: http://doi.org/10.4285/kjt.21.0020

Abstract

Background
As a solution to organ shortages, studies on kidney transplantation (KT) from older donors are being conducted. However, many controversies remain about its safety and efficacy.
Methods
In Samsung Medical Center, from January 2000 to May 2015, 1,141 patients underwent living KT. Cases of retransplantation, recipient and donor aged younger than 18 years, and multiorgan transplantation were excluded, and a total of 859 cases were selected. Analysis was performed by dividing the patents into two groups: a younger do-nor group (donors <60 years old; n=826) and an older donor group (donors ≥60 years old; n=33).
Results
There were no significant differences between the two groups in patient death (log-rank P=0.173) or in postoperative complications. The older donor group had a higher acute rejection (P=0.034; hazard ratio [HR], 1.704) and graft failure rate (P=0.029, HR=2.352). There was no significant difference in the trend of estimated glomerular filtration rate over time (P=0.189).
Conclusions
KT using kidneys from old-aged donors is safe, but there is room for improvement due to problems with higher acute rejection and graft failure rate

Keyword

Kidney transplantation; Living donors; Aged

Figure

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  Fig. 1 Study population. DDKT, deceased donor kidney transplantation; KT, kidney transplantation; FU, follow-up; hATG, horse antithymocyte globulin.

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  Fig. 2 Rejection and graft loss. (A) Kaplan-Meier curve of acute rejection rate in patients after living kidney transplantation. (B) Kaplan-Meier curve of graft survival rate in patients after living kidney transplantation. Number at risk is also shown below the graph.

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  Fig. 3 Estimated glomerular filtration rate (eGFR) over time. Renal function shown as eGFR is lower in the older donor group but the trend over time is not significantly different between the two groups. Number at risk is also shown below the graph.

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