Abstract
Living donors (LDs) are preferred over DDs for renal transplantation in children due to superior GS. Oslo University Hospital has never restricted living donation by upper age. The aim of this study was to investigate long-term outcomes using grandparents (GPLD) compared to PLD. Retrospective nationwide review in the period 1970-2017. First renal graft recipients using a GPLD were compared to PLD kidney recipients for long-term renal function and GS. 278 children (≤18years) received a first renal transplant: 27/251 recipients with a GPLD/PLD. GPLD (median 59 (42-74)years) were significantly older than PLD (median 41 (23-65)years, (P<.001). Median DRAD was 52 (38-70) vs 28 (17-48)years, respectively. GS from GPLD and PLD had a 1-, 5-, and 10-year survival of 100%, 100%, and 90% vs 93%, 82%, and 72%, respectively (P=.6). In a multivariate Cox regression analysis adjusted for gender, donor age, recipient age, and year of transplant, this finding was similar (HR 0.98; 95% CI 0.34-2.84, P=.97). Five-year eGFR was 47.3 and 59.5mL/min/1.73m2 in the GPLD and PLD groups (P=.028), respectively. In this nationwide retrospective analysis, GS for pediatric renal recipients using GPLD was comparable to PLD. Renal function assessed as eGFR was lower in the GPLD group. The GPLD group was significantly older than the PLD group, but overall this did not impact transplant outcome. Based on these findings, older age alone should not exclude grandparent donations.
Highlights
Living kidney donors are preferred for both children and adults with end-stage renal disease (ESRD), showing significantly better long-term graft survival (GS).[1,2] The policy for accepting living donors (LDs) for children depends in part on both cultural and social conditions
We have never applied an upper limit on donor age, or donor-recipient age difference (DRAD), but rather individually evaluated the renal function of each LD
We evaluated the risk of graft loss between pairs with a DRAD of more than 30 years vs those with an age difference of less than 30 years
Summary
Living kidney donors are preferred for both children and adults with ESRD, showing significantly better long-term GS.[1,2] The policy for accepting living donors (LDs) for children depends in part on both cultural and social conditions. Advanced age of a potential donor is regarded as a disadvantage, and many centers do not accept LDs older than 55 or 60 years for children.[3] At our center, we have never applied an upper limit on donor age, or DRAD, but rather individually evaluated the renal function of each LD. From the beginning of Abbreviations: ANCA, autoneutrophilic cytoplasmic autoantibodies; CAKUT, congenital anomalies of kidney and urinary tract; DD, deceased donor; DRAD, donor-recipient age difference; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; FSGS, focal segmental glomerulosclerosis; GBM, glomerular basement membrane; GFR, glomerular filtration rate; GPLD, grandparent living donor; GS, graft survival; HLA, human leukocyte antigen; HSP, Henoch-Schönlein Purpura; HUS, hemolytic uremic syndrome; LD, living donor; LRD, living-related donor; NNR, Norwegian Renal Registry; PLD, parental living donor; SD, standard deviation; SLE, systemic lupus erythematosus; Tx, transplantation.
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