20-Year Experience With Elderly Donors in Living Renal Transplantation M. Giessing, T. Slowinski, S. Deger, I. Tuerk, S. Scho ¨ nberger, K. Budde, and S.A. Loening ABSTRACT Purpose. This study evaluates the impact of living renal donors (LD) aged 60 years and older on graft performance and patient survival in an old-for-young constellation. Patients and Methods. We analyzed 144 consecutive LDs between January 1983 and December 2002 (19 patients 60+/125 controls). Results. Mean donor age in the 60+ group was 63.7 ( 2.6) years and 43.7 ( 9.0) years for the 60 group. Mean recipient age was 42.4 ( 15.2) years versus 32.6 ( 15.3) years HLA-A, -B, and DR-mismatches were 3.16 ( 1.3) for the 60+ group and 3.13 ( 1.7) for the controls (P = NS). Rejection episodes in the first year following LD did not differ (53% versus 33%, P = .25). Mean serum creatinine for 65+ versus 65 after 1, 3, and 12 months was 1.91  1.2 versus 1.48  0.85 mg/dL (P = .16), 1.82  0.89 versus 1.29  0.35 mg/dL (P  .05) and 1.80  0.31 versus 1.37  0.38 mg/dL (P  .05) and mean creatinine clearance at 12 months 62 versus 82 mL/min (P = .06). Censored 1-, 3-, and 5-year graft survival was 100% versus 95% (P = NS), 100% versus 93% (P = NS) and 100% versus 83% (P = NS) with no significant difference in the log-rank test for Kaplan Meier. Conclusion. No impact of donor age was found for graft survival but function of the 65+ kidneys at 3 and 12 months was reduced. Living renal donors 60+ are acceptable for carefully allocated recipients. F OR PATIENTS with end-stage renal failure, kidney transplantation most often is the best therapeutic option. Due to organ shortage, the waiting time for a cadaveric kidney has increased to about 5 years in Ger- many. One way to meet the growing demand for kidneys is a living donor (LD) renal transplantation. This has been increasingly practiced in the United States, where in 2000 the number of LD almost equaled that of cadaveric (CD) renal transplantation. While initially LDs were performed with kidneys from the preferred donor age group of 16 to 45 years, marginal older donors have become more accepted. This is due to the extension of donor criteria to expand the donor pool. 1–3 Multiple changes occur in the aging kidney. Structural alterations including loss of glomeruli, reduction of renal mass, and increase of the interstitial space have been described as well as changes in kidney function, including reduction of renal blood flow and glomerular filtration rate. 4 Furthermore, additional morbidity of the donors such as atherosclerosis, diabetis mellitus, and arte- rial hypertension affect graft quality and increase the risk of nonimmunologic parenchymal damage during transplanta- tion. The goal of expanding the donor pool while at the same time anticipating good graft function has fueled a controversy about using elderly living renal donors. 3,5–11 With the aim to evaluate the outcome of LDs of elderly donors and to increase the information about age-depen- dency of renal allografts, we performed a retrospective study of kidney transplantations realized in our department over the last 20 years. Included is a subgroup analysis for LDs after 1997, owing to the impact of changes in immu- nosuppression and posttransplant management over the years. From the Department of Urology (M.G., S.O., I.T., S.S., S.A.L.) and the Department of Nephrology (T.S., K.B.), Charite ´ Univer- sity Berlin, Berlin, Germany. Address reprint requests to Dr Markus Giessing, Charite ´ University Hospital, Department of Urology, Schumanstrasse 20-21, D-10098 Berlin, Germany. E-mail: markus.giessing@ charite.de © 2003 by Elsevier Inc. All rights reserved. 0041-1345/03/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2003.10.034 Transplantation Proceedings, 35, 2855–2857 (2003) 2855