Concerns about kidney longevity may limit the use of living donors ≥ 65 years. Previous studies have not considered competing risks of death or effect modification by recipient age. We studied 106,966 living donor recipients in the Scientific Registry of Transplant Recipients between 2000 and 2020 including 2,376 with donors ≥ 65 years for the outcome of allograft failure defined by return to dialysis or repeat transplantation. In a multivariable model accounting for the competing risk of death, the impact of donor age ≥ 65 years varied by recipient age: Compared to recipients < 35 years with donors < 35 years, the subdistribution hazard ratio (SHR) for allograft failure in recipients of donors ≥ 65 years were: SHR =1.77, 95% confidence interval (CI) 1.15 to 2.27 among recipients < 35 years; SHR =1.14, 95% CI 0.6 to 2.18 among recipients 35 to 49 years; SHR =0.72, 95% CI 0.38 to 1.39 among recipients 50 to 64 years; SHR = 0.65, 95% CI 0.33 to 1.29 among recipients ≥ 65 years. We conclude the allograft survival of living donor kidneys ≥ 65 years is similar to that of living donors aged < 35 years in recipients ≥ 35 years of age.
White et al. (Tue,) studied this question.