Experimental work has shown that donor age may alter the immune response of the recipient so that older donor grafts elicit a stronger response in the early period after transplantation. Clinical data supporting this notion was so far lacking.

Aim of the study was to see the impact of donor age to the frequency of rejection in both DBD and DCD kidneys.

Material and methods: Recipients of deceased kidney transplants in a single centre over 4 years were analysed for the presence of biopsy proven acute rejection. The rejection was correlated with donor and recipient age, matching, the presence of DGF and, given the differing immunosuppresion in age groups and types of donor, the induction used.

Results: During a 4-year period 338 deceased transplants took place in Cardiff (142 DBD, 196 DCD) with a median donor age of 58 years. 44.7% of the donors and 47% of the recipients were over 60 years old. 75% of DBD kidney recipients received Basiliximab induction as opposed to 66% of DCD recipients receiving either ATG or Campath induction and 34% Basiliximab.

There was no difference between the rejection rates of younger vs. older recipients (p=0.47) but this might have been affected by the mal-distribution of the induction used in those 2 subpopulations. There was a 15.2% vs. 7.5% rejection rate in the older donor kidney recipients (Fisher exact test p=0.03, OR 1.1-4.8).

In order to avoid potential confounders, we performed binary logistic regression. The older donor age was the only significant factor for rejection (p=0.008) whereas the recipient age, DGF, overall mismatch and DR mismatch were not.

In subgroup analysis in DBD donors again only donor age was significant factor for rejection (p=0.009) whereas in DCD kidneys, only the induction regime was significant for rejection (p=0.017) (whereas donor age was not) with significantly less patients on Campath or ATG having rejections compared to basiliximab (7.9 vs. 13.8%).

Conclusion: This is the largest clinical study showing that senescence of the donor kidney affects the rejection rate in the modern immunosuppressive era particularly in brain dead donor kidneys. This is not mediated via DGF. We do not know whether it is that aggressive induction in DCD donor kidneys in our centre is blocking this effect or the phenomenon is altogether absent in the absence of the brain storm that follows the brain death.

CITATION INFORMATION: Khalid U, Donato P, Szabo L, Chavez R, Ablorsu E, Asderakis A. The Effect of Donor Age on Acute Rejection Age – The Clinical Impact of Donor Immuno-Senescence in the Modern Immunosuppressive Era. Am J Transplant. 2016;16 (suppl 3).

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