Clinical Outcomes of Living Kidney Transplantation from Older Adult Donors Aged 70 Years and Older: A Multicenter Study of Seven Kidney Transplantation Centers in Japan

The persistent organ shortage has led to the consideration of "marginal" donors, including those of advanced age, but the outcomes of using living kidney donors aged 70 years or older remain debated. This multicenter retrospective cohort study aimed to evaluate the propriety of kidney donation from older adult donors by analyzing the association between transplant outcomes and recipient age. Using data from 633 adult living-donor kidney transplants, we compared an elderly donor group (age ≥70 years, n=75) with a non-elderly donor group (age <70 years, n=558). After 1:1 propensity score matching, the elderly donor group showed significantly lower death-censored graft survival. However, this disadvantage disappeared entirely in recipients aged 50 years or older, who exhibited comparable death-censored graft survival to those with non-elderly donors ( p =0.743). In contrast, recipients younger than 50 years who received grafts from elderly donors had markedly inferior death-censored graft survival ( p =0.008). In conclusion, using living kidney donors aged ≥70 years is a viable strategy to expand the donor pool, but its success is influenced by recipient age. These results support an age-sensitive approach in counseling and decision-making for kidney transplantation.