THE INFLUENCE OF DONOR AGE ON GRAFT-SURVIVAL IN RENAL-TRANSPLANTATION

The current supply of kidneys from cadaver and living related donor sources is not sufficient to meet the demand. As a result, alternative sources of renal allografts are being explored, including very young donors and anencephalic newborns. However, data on the success of transplanting kidneys from very young donors are limited and conflicting. The purpose of this study was to determine whether the function and survival of renal grafts obtained from newborns and very young donors is different from that for grafts obtained from older donors. Thirty-six cadaveric donors under the age of 3 years, including seven anencephalic newborns, were evaluated. Allograft recipients ranged in age from 12 months to 57 years. The clinical outcome for these donor organs was compared with the graft survival for 136 kidneys transplanted from cadaver donors over age 3 years at our institution. There was a 65% 6-month and 64% 1-year graft survival in recipients of kidneys from donors greater than or equal to 3 years. Survival of grafts from donors under 12 months of age (n=16) was significantly decreased compared with donors age 3 years and older, with a 31% 6-month (P<.01) and 19% 12-month survival (P<.001). Grafts obtained from anencephalic donors did not differ in survival or function from kidneys obtained from other donors less than 12 months of age. Survival for renal allografts from donors age 13 months to 3 years was also decreased relative to older donors: 55% at 6 months (P>.1) and 40% at 1 year (P<.05). Graft survival from donors age 3 to 5 years was analyzed separately and was not significantly different from that of donors over age 5. Allograft survival was similar for single kidney and en bloc duplex renal grafts, and was not influenced by the age or size of the recipient or by duration of cold ischemia. The most frequent cause of graft loss was early nonfunction in the presence of anastomotic patency and was not influenced by recipient size and age. Mechanisms responsible for this process have not yet been characterized. These data indicate that increased efforts must be directed at defining the etiology of primary graft nonfunction and developing improved techniques for preservation of allografts obtained from very young donors for this potential resource to be used with efficiency. © 1990 W.B. Saunders Company.