Long-term survival after transanal resection: A. J. Dickinson et al.

Whilst HLA matching is routine for renal transplantation, the possible benefits of matching donor and recipient age have not been previously examined. In this study we examined the simultaneous effect of donor to recipient age difference on the graft survival of 141 consecutive first cadaver transplant recipients treated by cyclosporin immunosuppression. Multivariate regression analysis, taking into account other variables of moderately matched recipients (i.e. dialysis time and type, donor/recipient sex, local/imported kidneys, recent sensitivity, total ischaemic time, preoperative transfusions), indicated that age-difference was the single most important variable (P less than 0.05). Individually there was no significant effect of recipient age, whilst older donors (aged greater than 50 years) were associated with significantly worse graft survival than those younger (P less than 0.01). When dealing with donors aged greater than or equal to 50 years the corresponding recipient 1-year graft was improved when the donor was no more than 5 years older than the transplant recipient. Donor age to recipient age difference is a potentially important selection criterion in renal transplantation.

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The ever rising demand for renal transplantation has led to an increased use of older (>50 years) organ donors [9]. Previous studies have shown that donor-to-recipient age difference is an independent risk factor for allograft survival [3]. A recent multicentre study of 6397 first cadaver renal transplants showed that, where donors are more than 5 years older than the recipient, there is significantly impaired graft survival [11]. The mechanism of this effect is unclear, but it has been suggested that age-related donor factors may influence subsequent graft function.Pathological studies have shown that native kidneys acquire specific histological (i.e. glomerulosclerosis, interstitial fibrosis) and functional defects in a linear fashion related to increasing age [1,5]. Whilst graft loss may be seen as the worst outcome from using older donors, impaired function leading to shortened half-life may also occur. Recipients of kidneys from donors > 50 years of age also have a significantly higher creatinine than those from donors <50 years of age [3]. A study was therefore undertaken to investigate in greater detail the effect of age on the function of donor kidneys in their respective recipients.

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