Does donor–recipient age difference matter in outcome of kidney transplantation? Implications for kidney paired donation

Abstract

Background: Kidney paired donation (KPD) is a rapidly growing modality for facilitating living donor kidney transplantation (LDKTx) for patients who are incompatible with their healthy, willing and living donor. The impact of donor-recipient age difference on long and short-term graft and patient survivals in LDKTx is still uncertain. Methods: A total of 1502 LDKTx recipients who received regular follow-up in our center from 1999 to 2012 were studied. Donor-recipient age difference was divided into subgroups (donor-recipient 0À10, 11-20, 0-20, 21-30, 31-40, and 21-40 years). Outcome measures included death censored graft, patient survival and acute rejection rate. Results: The 1-, 5-, 10-year patient survival of the donor-recipient age difference 20 years group showed no difference compared with the age difference 420 years group (94.5%, 83.2%, 71.9% and 95.2%, 86%, 77.8%, p ¼ 0.053). The 1-, 5-, 10-year graft survival of the donor-recipient age difference 20 years group showed no difference compared with the age difference420 years group (94.6%, 81.6%, 72.1% and 94%, 80%, 72.2%, p ¼ 0.989). The rejection were also similar (17.5% vs. 16.5%, p40.05). There was no statistically significant difference in graft survival and acute rejection rate in all subgroups. Conclusions: Older donors (usually within families) are not associated with worse outcome is reassuring. KPD should not be prohibited due to high donor-recipient age difference, when size of donor pool is small as in single center KPD program.

The impact of donor/recipient age difference and HLA mismatch on graft outcome in pediatric kidney transplantation

“…A number of adult studies have reported that increasing age of the donor is associated with worse graft survival in both DD and LD recipients . In contrast, some adult and pediatric studies have reported good long‐term graft outcomes irrespective of donor age, including in recipients of kidneys from older donors . There was no significant association between the donor age and graft outcomes in our study either for the whole cohort or separately for LD and DD transplants recipients.…”

Increasing access to kidney transplantation in countries with limited resources: The Indian experience with Kidney Paired Donation

“…Although KPD was underutilized in India, recently, KPD transplantation has been performed more frequently . KPD is feasible for any centre that performs LDKTx.…”

Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study

“…KPD is underutilized in India due to the lack of a KPD registry in the national programme; a lack of single‐centre KPD practice; a lack of harmony and coordination among different transplant units; variable healthcare costs and quality; a lack of uniform evaluation and follow‐up care for transplant patients and donors; inefficient matching algorithms; and legal, regulatory, logistical and economic barriers. Our centre in Ahmedabad, India, has pioneered KPD transplantation over the last few years . KPD has increased access to LDKT in national and single‐centre programmes across the world .…”