Older living kidney donor age may be negative predictor of recipient, graft survival
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Compared with living donors aged 50 to 70 years, donor age older than 70 years may be a negative predictor of kidney transplant and graft survival, according to a presentation at the American Transplant Congress.
“I set out to see if the data and outcomes of a national cohort met my anecdotal findings that living kidney donor transplants from donors [older than] 70 years don’t perform as well compared to their younger donor counterparts regardless of measured donor GFR and noted that this had not been studied in a contemporary cohort in the past 10 years,” Adam Bregman, MD, MBA, an assistant professor of medicine in the division of nephrology and hypertension at the University of Minnesota, told Healio.
Researchers identified kidney transplant recipients from older living donors aged 50 to 60 years (n=12,455), aged older than 60 to 70 years (n=5,072) and aged older than 70 years (n=398). All data were derived from the Scientific Registry of Transplant Recipients.
Using Kaplan-Meier curves, researchers measured 5-year recipient and death-censored graft survival by donor age. Cox proportional hazard models determined the correlation between donor age and outcomes of interest. Researchers adjusted models for donor and recipient factors.
Overall, 51% of living donors older than 70 years donated to recipients in the same age group. The Kaplan Meier curves revealed recipients in the oldest living donor groups showed lower survival rates in a stepwise fashion. Additionally, those older than 70 years had the lowest survival, but the pairwise comparison only showed the difference between living donors aged older than 70 years and donors aged 50 to 60 years. Similarly, the multivariable model for recipient survival showed ones paired with living donors aged older than 60 years correlated with higher mortality.
“We are in the midst of publishing this data along with an inverse probability weighting analysis of recipient characteristics to better ‘tease out’ the effect of donor age and it seems that recipient graft outcomes are still worse with older living donor kidneys than those from a younger cohort,” Bregman told Healio. “The goal would be to make a decision analysis that would help the transplant clinician, transplant center and potential recipient decide whether to take a living donor kidney from an older donor vs. waiting for either a younger living donor kidney via paired exchange or wait for a deceased donor kidney transplant.”
He concluded, “It is worth noting that this was retrospective data and outcomes were not compared against recipients of deceased donors or remaining on the waitlist. The results of this study should not deter potential kidney recipients from accepting a living donor kidney transplant from a donor older than 70 years as that kidney transplant likely will still improve lifespan and quality of life compared to remaining on the waitlist and possibly on dialysis.”
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Bregman A. et al. Abstract 1042. Presented at: American Transplant Congress; June 4-8, 2022; Boston (hybrid meeting).
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