Donation From Old Living Donors
The selection of the LKD is much dependent on renal function. We meet old people with low GFRs in our outpatient clinics, but we have less knowledge of renal function in the old population that is supposed to be in good health. The study known as the Three French Cities study reported eGFR (MDRD) in 8705 people aged 65 or more. Among them, 10.2% had over 90 mL/min/1.73 m and 76.9% were between 60 and 89 mL/min/1.73 m. A study from the Nijmegen Biomedical study also provided age and gender references for eGFR in a population without expressed risk (no hypertension, no diabetes, no cardiovascular nor renal disease). GFR was estimated by the MDRD formula in 1660 males and 2072 females, with 869 in each group having ≥65 years of age. The data showed that old to very old subjects eventually have good to excellent renal function. Finally, the pool of old donors with sufficient GFRs for donation is probably wider than we imagine.
The GFR above 80 mL/min/1.73 m is usually considered as the gold standard for LKD selection, but the UK recommendations propose a different threshold adapted to the age of the donor. It is defined as the GFR value at donation that will allow the donor to have at least 30 mL/min/1.73 m at the age of 80. This value is 86 mL/min/1.73 m up to the age of 40, 77 at the age of 50, 68 at the age of 60, 59 at the age of 70, 50 at the age of 80. These numbers result from an evaluation of GFR decrease of the remaining kidney with age. They have not been validated by clinical studies to date, and we have to be cautious as the evaluation of renal function decrease is based on age only and does not take into account that the donor can develop, in the long term, risk factors for CKD.
The pool could be further expanded if we extend our selection criteria and consider donors with minor abnormalities. Most European centres are reluctant to use obese donors, but they are accepted in the USA. Although obesity increased the risk of complications, hypertension and reduced GFR, the safety results are considered acceptable. Larger studies are certainly needed.
What Is the Pool of the Old Living Donors?
The selection of the LKD is much dependent on renal function. We meet old people with low GFRs in our outpatient clinics, but we have less knowledge of renal function in the old population that is supposed to be in good health. The study known as the Three French Cities study reported eGFR (MDRD) in 8705 people aged 65 or more. Among them, 10.2% had over 90 mL/min/1.73 m and 76.9% were between 60 and 89 mL/min/1.73 m. A study from the Nijmegen Biomedical study also provided age and gender references for eGFR in a population without expressed risk (no hypertension, no diabetes, no cardiovascular nor renal disease). GFR was estimated by the MDRD formula in 1660 males and 2072 females, with 869 in each group having ≥65 years of age. The data showed that old to very old subjects eventually have good to excellent renal function. Finally, the pool of old donors with sufficient GFRs for donation is probably wider than we imagine.
The GFR above 80 mL/min/1.73 m is usually considered as the gold standard for LKD selection, but the UK recommendations propose a different threshold adapted to the age of the donor. It is defined as the GFR value at donation that will allow the donor to have at least 30 mL/min/1.73 m at the age of 80. This value is 86 mL/min/1.73 m up to the age of 40, 77 at the age of 50, 68 at the age of 60, 59 at the age of 70, 50 at the age of 80. These numbers result from an evaluation of GFR decrease of the remaining kidney with age. They have not been validated by clinical studies to date, and we have to be cautious as the evaluation of renal function decrease is based on age only and does not take into account that the donor can develop, in the long term, risk factors for CKD.
The pool could be further expanded if we extend our selection criteria and consider donors with minor abnormalities. Most European centres are reluctant to use obese donors, but they are accepted in the USA. Although obesity increased the risk of complications, hypertension and reduced GFR, the safety results are considered acceptable. Larger studies are certainly needed.
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