"With looming changes to organ allocation in the U.S., living donor transplants from older living donors may prove to be an important avenue for elderly patients awaiting kidney transplantation," researchers report in the American Journal of Kidney Diseases.
Led by Dr. Jagbir Gill at the University of British Columbia in Vancouver, the research team studied 23,754 kidney transplant recipients 60 years or older at the time of transplantation, which was from 1996 to 2005.
Nearly one third received kidneys from living donors; 1,133 donors were older than 55 years and 5,873 were younger.
Among deceased donors, 1,219 met the standard donor criteria and 4,551 were "expanded criteria donors," defined as donors older than 60 or those between the ages of 50 to 59 with two of three adverse conditions: high blood pressure, a history of stroke, or terminal serum creatinine level greater than 1.5 milligrams per decaliter, a sign of kidney dysfunction.
After a more extensive analysis, the researchers found that graft survival was superior in all recipients of living donor transplants compared with deceased donor transplants," Gill's team reports.
Among living donor recipients, 4-year patient survival was only slightly better for younger donors than for older donors (84.2 percent vs. 82.4 percent). Corresponding rates in recipients of standard-criteria and expanded-criteria donors were 78.5 percent and 67.5 percent, respectively.
In further analysis, the relative risk of death was nearly tripled for organs from expanded-criteria deceased donors compared with those from older living donors.
Survival at 4 years was greater than 80 percent, even among recipients of kidneys from the oldest living donors (over age 65), the report indicates.
"New proposals to amend organ allocation are putting considerable emphasis on increasing the number of functioning years gained from each diseased donor kidney transplant," the authors note, a policy likely to result in even longer wait times for elderly patients who are already at increased risk of dying before an organ becomes available.
Therefore, they advise, "Our findings support the practice of living donor transplantation with appropriately selected older living donor in elderly recipients whenever possible."
Although older donors did not appear to suffer more complications than their younger counterparts, follow-up data were available for fewer than 25 percent. "Clearly," Gill and his group conclude, "there is a need for further prospective study of donor outcomes, and multiple centers are developing donor registries for this purpose."
SOURCE: American Journal of Kidney Disease, September 2008.
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