Abstract
Kidney transplantation is among the most effective therapies for patients with end-stage renal disease (ESRD). However, dialysis therapy is more commonly used compared to kidney transplantation in ESRD patients because of the shortage of donors in Japan. The gap between the number of wait-listed patients for kidney transplantation and the number of donations has forced transplant institutions to consider kidneys that are normally not considered for transplantation. These so-called marginal donors include cadaveric donors whose kidneys are of suboptimal quality and elderly living donors who have one or all of these conditions: hypertension, obesity, and diabetes. The most common problems with the use of marginal donors in transplantation are slow and delayed graft functions and graft failure in the short and long terms after kidney transplantations, respectively. Because the acceptability of elderly living kidney donors remains controversial, we summarized the outcomes of kidney transplantations from these donors in our institute. The risk of slow, but not delayed, graft function was higher in the kidney transplant patients who received transplants from elderly living kidney donors than those who received transplants from young donors. No significant difference in death-censored long-term graft survival rate was observed between patients who received transplants from young donors and those who received transplants from elderly donors. However, patient survival rate was significantly lower among the latter than among the former. These findings support the use of grafts from elderly living donors for kidney transplantation. When both the recipient and marginal living donor are well informed of the potential risks, kidney transplantation with suboptimal kidneys can be a better choice for eligible patients with ESRD.
