Donation from old living donors: how safe is it?

As the rate of living kidney donor (LKD) transplantations increases, the selection of extended criteria donors such as old donors (>60-65 years) becomes more common. The pool of these old donors is probably wider than we think, especially if we tolerate a lower glomerular filtration rate (GFR) than the gold standard of 80 mL/min/1.73 m(2). Several important studies with large cohorts of living donors including old subjects have been published these last few years and give insights on the outcome in this subpopulation. The risk of death and end-stage renal disease (ESRD) is similar to that of matched controls from the general population. Post-donation GFR, as a result of glomerulopaenia, is lower in old than in younger donors but pre-donation as well as the rate of function loss is not different between young and old donors. Nearly 80% of donors over 60 have <60 mL/min GFR post-donation, the risk of cardiovascular mortality and progression to ESRD in the long term, as in the general population, is under question. Despite reduced renal function of the old kidney, the results of transplantation from an old living donor appeared to be equivalent to deceased transplantation from a younger donor. Finally, transplantation from an old living donor appeared to be a reasonably safe procedure for both the donor and the recipient and the age per se is certainly not a contraindication to donation.

Effect of brain-dead donor resuscitation on delayed graft function: results of a monocentric analysis.

BACKGROUND: We have previously shown that a delayed graft function (DGF) longer than 6 days was a crucial threshold for long-term graft outcome. The aim of this study was to analyze the correlation of DGF >or=6 days with brain-dead donor variables, including those related to resuscitation, in a population of 262 consecutive brain-dead donors from 1990 to 2003. METHODS: We used a marginal logistic model in which DGF was considered as a binary variable with a cutoff of 6 days. RESULTS: Monovariate analysis of donor parameters showed that male, age above 35 years, primary history of hypertension, hydroxyethyl starch (HES) fluid greater than 1500 mL or epinephrine infusion during resuscitation were risk factors for prolonged DGF. The multivariate logistic regression model showed that epinephrine use during donor resuscitation (P<0.001, odds ratio [OR]=4.35), cold ischemia time (CIT) >or=16 hr (P=0.01, OR=2.16), and recipient age >55 years (P=0.003, OR=2.75), were associated with a risk of prolonged DGF. A long stay (>40 hr) in intensive care and a large volume of colloids (>1250 mL, except HES) correlated with a lower risk of DGF. CONCLUSION: Our study shows an impact for only a limited number of brain dead donor resuscitation parameters on DGF duration. We also show that CIT has a much lower threshold (<16 hr) for DGF risk than previously described. Importantly, we show that recipient age is clearly a major independent risk factor for prolonged DGF, whereas donor age seems to act mostly as a dependent risk factor.