Outcomes of Kidney Transplants From Elderly Living Donors: A Retrospective Cohort Study in Japan

Background: Kidney transplantation (KT) is an effective treatment for end-stage renal disease. The demand for living-donor kidney transplantation (LDKT) in the elderly is increasing in Japan. However, evidence of long-term outcomes remains limited. This study aimed to investigate long-term graft survival in elderly donors. Methods: This retrospective cohort study, conducted as part of the Japan Academic Consortium of Kidney Transplantation, analyzed data from 933 adult LDKT recipients between 1995 and 2011. Recipients were categorized by age at LDKT as follows: < 64, 65-69, and > 70 years. The primary outcomes were graft loss (not censored for death) and recipient survival (death with a functioning graft). Statistical analyses included Kaplan-Meier survival curves and log-rank tests. Results: The 10-year graft survival rates were 86.3%, 77.7%, and 68.1% for donors aged < 64, 65-69, and > 70 years, respectively (p < 0.001). However, the recipient 10-year survival rates were comparable across the groups. Conclusions: Although advanced donor age was associated with lower graft survival, long-term recipient outcomes remained favorable. Compared to dialysis, elderly LDKT provides significantly better survival outcomes, making it an acceptable option amid Japan's prolonged donor shortage. This study was approved by the Ethics Review Committee of Tokyo Women's Medical University (Approval No. #3366) and registered with the University Hospital Medical Information Network (UMIN000018327).