Background The living donor kidney transplantation (LDKT) is well known for best treatment of end-stage renal disease. Recently, kidney transplantation from elderly living donor has been increasing. However, the impact of donor age on LDKT outcomes has not been well established in Asian recipients.

Methods This multicenter cohort study included adult kidney transplant recipients admitted to 5 major tertiary hospitals in Korea between 1997 and 2012. In all, 2,595 adult participants were enrolled. Patient survival, allograft survival, and biopsy-proven acute rejection (BPAR) were compared by the donor age group.

Results Patients were divided into 5 groups according to donor age at transplantation. The proportions of donor with 50 to 59 years and elderly donor (≥ 60 years) were 18.3% and 2.9 %, respectively. Despite of difference in donor age, mean recipient age were similar between the groups. Elderly donors were more likely to donate their kidneys to unrelated recipients. The proportions of recipients with diabetes mellitus history (29.7%) and pretransplant ischemic heart disease history (8.2%) were significantly higher in the elderly donor group than in the other donor age groups. In elderly donor group, recipients' overall mortality rates seemed to be higher than other donor age groups (p=0.013). However, multivariate Cox regression analysis revealed that donor age did not affect the recipients' survival (p=0.232). Moreover, death-censored allograft survival rate was not affected by donor age (p=0.949, hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.36-2.94). Interestingly, the BPAR free survival decreased as patient age increased (P = 0.002).

Conclusion Increased donor age could not affect allograft survival. Living donor kidney transplantation with elderly donor could be more encouraged.

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