Study shows age matching of kidney donor-recipient influences long-term outcomes
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Kidneys utilized during living donor transplants may have a lower likelihood of survival if not age matched to the recipient, according to data presented at the American Transplant Congress.
“Living donor kidney transplantation has emerged as the preferred long-term treatment of patients with end-stage kidney disease,” Neel K. Prabhu, BSE, a researcher at Duke University School of Medicine, told Healio. “With more patients able to become living kidney donors in the modern era, there may be multiple suitable living donors for a patient listed for transplant.
“However, research is limited on how to select the right donor such that the donated kidney functions to its full potential and provides maximum benefit to the recipient. We performed this study to analyze whether the age difference between the donor and recipient would affect outcomes after living donor kidney transplant.”
Prabhu and colleagues reviewed characteristics of living donor-recipient pairs listed in the United Network for Organ Sharing (UNOS) database from 2000 to 2019. They used a multivariable Cox proportional hazards model to evaluate the association of recipient-recipient-donor age difference with risks of death-censored graft loss and death with a functioning graft.
“Recipient-donor age or age difference was defined for analysis as follows: difference [greater than] 20 years, difference [less than] 20 years and a reference group of age difference within [plus or minus] 20 years,” the researchers wrote in their abstract.
The UNOS data showed 111,407 living donor kidney transplants were performed in the study timeframe. The mean donor and recipient age increased annually from 39.8 and 44.4 years, respectively, in 2000 to 44.3 and 50.6 years, respectively, in 2019.
Results showed that, compared with the reference group, “younger recipients of older donors experienced an increased risk of death-censored graft loss, ... while older recipients of younger donors had a decreased risk of death-censored graft loss,” the researchers wrote in their abstract.
“In analyzing death with functioning graft, the opposite results were observed: Younger recipients of older donors experienced decreased risk of death, ... while older recipients of younger donors had increased risk of death ... compared to the reference group,” they wrote.
“We found that when older patients received a kidney from donors more than 20 years younger, they were more than twice as likely to eventually die with their kidney graft still functioning,” Prabhu told Healio. “We also found that when younger patients receive a kidney from donors more than 20 years older, they were nearly twice as likely to experience kidney graft failure before death.”
“Together, these findings suggest that donor-recipient matching is not yet optimized in living donor kidney transplantation,” Prabhu said. “Namely, older kidneys in younger patients do not provide maximum benefit to the recipient, and younger kidneys in older patients have unrealized life-years. This is clinically relevant because careful selection of donor-recipient pairs, for instance through living donor exchange programs, could potentially correct the mismatch and decrease the need for a second transplant in the younger patients.”
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Prabhu NK, et al. Abstract 1715. Presented at: American Transplant Congress; June 4-8, 2022; Boston (hybrid meeting).
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