Abstract Type : Oral presentation
Abstract Submission No.: A-0433
Abstract Topic : Transplantation

Clinical Outcomes of Kidney Transplantation from Older Donors: Does Advanced Donor Age Matter? A Nationwide Cohort Study

Jeeyoung Yoon¹, Byung Ha Chung ¹, Sangil Min², Kyu ha Huh³, Seun Deuk Hwang⁴, Jaeseok Yang⁵, Myoung soo Kim⁶, Hye Eun Yoon¹
¹Department of Internal Medicine-Nephrology, The Catholic University of Korea Seoul St. Mary's Hospital , Korea, Republic of
²Department of Surgery, Seoul National University Hospital, Korea, Republic of
³Department of Surgery-Transplantation, Severance Hospital, Korea, Republic of
⁴Department of Internal Medicine-Nephrology, Inha University Hospital, Korea, Republic of
⁵Department of Internal Medicine-Nephrology, Severance Hospital, Korea, Republic of
⁶Department of Surgery, Severance Hospital, Korea, Republic of

Objectives : The global shortage of kidney donors has led to increased use of older donors. We evaluated clinical outcomes of kidney transplant recipients (KTRs) from older donors according to donor and recipient age.
Methods : We analyzed 2,205 KTRs who received kidneys from older donors (≥60 years) between April 2014 and December 2023 using a nationwide registry cohort. Recipients were stratified by donor age (60–69 vs. ≥70 years) and recipient age (<60 vs. ≥60 years). Kaplan–Meier analyses with log-rank tests compared all-cause mortality, overall graft failure, death-censored graft failure (DCGF), and biopsy-proven acute rejection (BPAR) rates. Multivariable Cox proportional hazards analysis identified predictors of outcomes expressed as hazard ratios (HRs) with 95% confidence interval (CI).
Results : KTRs receiving kidneys from donors ≥70 years (n=250) had higher overall graft failure and mortality than those receiving kidneys from donors aged 60-69 years (n=1,955; both P<0.001), whereas DCGF (P=0.10) and BPAR rates (P=0.18) were similar. Among recipients aged ≥60 years (n=967), overall graft failure (P=0.0014) and mortality (P=0.0024) remained higher in the ≥70-year donor group, while DCGF (P=0.23) and BPAR rates (P=0.47) did not differ. In recipients aged <60 years (n=1,238), outcomes were not significantly different between donor age groups. In multivariable analysis, recipient age independently predicted graft failure (HR, 1.02; 95% CI, 1.00 – 1.03; P=0.03) and mortality (HR, 1.06; 95% CI, 1.05 – 1.11; P<0.001), while advanced donor age was not independently associated with transplant outcomes.
Conclusions : Although advanced-age donors (≥70 years) were associated with lower overall graft and patient survival, particularly among older recipients, graft-specific outcomes were similar between donor age groups. Recipient age, rather than donor age, was a key determinant of post-transplant outcomes. These findings suggest that advanced donor age alone should not preclude kidney utilization.

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