Age-matching in renal transplantation

Background. So far, the combined influence of donor age and recipient age on renal allograft survival has not been investigated sufficiently. In this retrospective single-centre study we analysed whether the influence of donor age and recipient age on renal allograft survival are dependent on each other. Methods. Data from 1269 cadaveric renal allograft transplantations were evaluated. Paediatric donors (<15 years) and paediatric recipients (<15 years) were excluded. Donors and recipients were divided by age: young donors (yd, less than or equal to 55 years, n = 1093), old donors (od, >55 years, n = 176), young recipients (yr, less than or equal to 55 years, n = 1058), and old recipients (or, >55 years, n = 211). Functional and actual long-term graft survival (8 years) within the four resulting groups was determined: yd/yr (n = 926), yd/or (n = 167), od/yr (n = 132), and od/or (n = 44). Results. Univariate analysis showed that long-term graft survival of both, kidneys from young donors (functional, 66.1 vs 52.2%, P = 0.004; actual, 53.3 vs 46.2%, P = 0.065) and kidneys from old donors (functional, 68.7 vs 22.5%, P = 0.07; actual, 57.1 vs 20.8%, P = 0.15) was better in old recipients as compared to young recipients. Multivariate regression analysis revealed that actual graft survival of kidneys from old donors was significantly reduced in young recipients (od/yr) as compared to all other groups (P = 0.001; RR, 1.97; 95% CI, 1.32-2.94). In this group of patients, graft loss was mainly due to acute (33.7%) and chronic (24.0%) rejection. Conclusion. Transplantation of kidneys from 'old' donors into 'young' recipients should be avoided, and these kidneys should be given to age-matched recipients.