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.