Donor-recipient age difference?an independent risk factor in cyclosporin-treated renal transplant recipients

Abstract

Whilst HLA matching is routine in renal transplantation the possible benefits of matching donor to recipient age have not been previously explored. The simultaneous effect on graft survival of donor and recipient age was therefore investigated for 274 consecutive first cadaver transplant recipients treated by cyclosporin immunosuppression in two centres. The overall graft survival was 77%, and was not significantly different between the two centres. Individually there was no significant effect of donor or recipient age but taken together, the difference in age significantly affected graft survival (P less than 0.01) regardless of the mode of failure. The 1-year graft survival for all failures was 66.2% when the donor was 5 or more years older. 84.5% when the donor was 5 or more years younger and 71.7% when the donor was within 5 years of the recipient's age. Multivariate analysis, taking into account other variables (HLA matching, dialysis time and type, donor/recipient sex, local/imported kidneys, sensitivity, operation time, total ischaemic time, pre-operative transfusions) indicated that age difference was the single most important variable (P less than 0.01). The only other important covariate risk factor in improving graft survival was HLA-DR matching (P less than 0.05). Donor-recipient age difference is a potentially important recipient selection criterion in cyclosporin-treated renal transplant patients.

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

“…The possibility that older recipient age per se may confound the results of studies examining outcomes associated with donor age led to the emergence of donor/recipient age difference as more robust predictor of allograft outcomes. [21][22][23] In keeping with these reports, our study has shown that increasing donor/recipient age difference is associated with poorer long-term graft survival, with an approximately 10% increase in graft loss for every 10-year increase in donor/recipient age difference. At the other end of the continuum of donor/recipient age difference, studies have also shown good outcomes for pediatric patients who received DD kidneys from donors younger than their recipients.…”

“…There have only been limited studies on the relative impact of donor/recipient age and HLA matching on kidney graft outcomes. In an adult study performed over 20 years ago in the cyclosporine era, Donnelly et al21 found that close age matching between donors and recipients (donors younger or up to 5 years older than recipients) and HLA DR matching were associated with improved 1-year graft survival.A more recent study of adult LD kidney recipients found that HLA matching had a much stronger relationship with graft survival when compared to donor age 34. Utilizing the US Renal Data System, Fosteret al 35 modeled adjusted 5-year probability of graft survival data from a large pediatric and young adult (<21 years of age) population.…”

Effects of Aging on Kidney Graft Function, Oxidative Stress and Gene Expression after Kidney Transplantation

“…Despite improvements in KT techniques, whether and how donor and recipient age affect graft function and patient survival after KT remain debatable. Conflicting results have been reported regarding the effects of donor age [3]–[6], recipient age [7], [8] and donor-recipient age difference [9], [10] on short- and long-term outcomes after KT.…”