Influence of Donor Age on Graft and Patient Outcomes in Kidney Transplantation: A Systematic Review and Meta-Analysis.
Gerhard Reinaldi Situmorang, Rizki Usaputro, Irfan Wahyudi et al.
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In 30 seconds
This systematic review and meta-analysis assessed how donor age relates to graft and patient outcomes after kidney transplantation, pooling seven observational studies involving 19,210 recipients. Older donor age was associated with greater risk of death-censored graft loss (HR 1.73; 95% CI: 1.34-2.24) and patient mortality (HR 1.42; 95% CI: 1.05-1.94), particularly for donors aged >60 years. Acute rejection rates did not differ significantly between older and younger donor groups. The authors conclude that older donors may remain acceptable with appropriate recipient selection and age matching.
Key findings
- Older donor age was associated with increased death-censored graft loss (HR 1.73; 95% CI: 1.34-2.24).
- Older donor age was associated with higher patient mortality (HR 1.42; 95% CI: 1.05-1.94), particularly among donors aged >60 years.
- Acute rejection did not differ significantly between older and younger donor groups (OR 0.86; 95% CI: 0.60-1.23).
Why it matters
Donor age may inform assessment of expected graft and recipient outcomes as transplantation programs use older donors to expand the organ pool. The findings highlight a potential trade-off: older donor age was associated with poorer survival outcomes, while acute rejection rates were not significantly different. These associations can support careful consideration of donor and recipient characteristics without implying that age alone determines transplant suitability.
What to keep in mind
The evidence came from only seven observational studies, with potential residual confounding and clinical heterogeneity; moderate-to-high heterogeneity was reported for survival outcomes.