The disparity between donor kidney availability and demand has increased utilization of kidneys from marginal living donors. Data regarding outcome of transplantation from living donors with high Body Mass Index (BMI) and elderly donors is limited. Our aim was to compare graft outcomes from elderly living donors and donors with high BMI.

Data was prospectively collected on consecutive recipients from live donors in 2002-2012. We excluded donors with history of pre-donation hypertension. Donors were categorized as elderly (≥ 60 years) or younger and with high (≥ 30) or normal BMI.

We included 449 patients who received a kidney from a living donor. Follow up was 74 months (median, range 3-145). 64 patients lost their grafts and 34 patients died. Recipients with donors of Afro-Caribbean (AC) ethnicity were more likely to lose their grafts (p=0.019). Receiving a kidney from an elderly donor (p=0.724) or a donor with high BMI (p=0.410) was not associated with graft loss. Median eGFR at 3 and 5 years for kidneys from younger donors was 55 ml/min (range 14-93) and 50 ml/min (range 17-73), respectively and from elderly donors it was 42 ml/min (range 19-66) and 34 (range 24-51), respectively (p=0.001 for both). Median eGFR at 3 and 5 years was similar between recipients from donors with normal BMI (53 ml/min, range 14-93 and 48.5 ml/min, range 17-90, respectively) and high BMI (48 ml/min, range 33-90 and 48 ml/min, range 38-83, respectively) (p=0.966 and p=0.546, respectively). Death-censored graft survival was similar regarding kidneys from elderly and younger donors (log rank p=0.639) and from donors with normal or high BMI (log rank p=0.350). Patient survival was similar in recipients with donors with high or normal BMI (log rank p=0.159) and with elderly or younger donors (log rank p=0.588). In Cox-regression, receiving a kidney from an AC donor (p=0.02) and rejection (p<]0.001) increased the risk of graft loss, whereas a kidney from an elderly donor (p=0.632) or a donor with a high BMI (p=0.359) did not increase the risk for graft failure.

Receiving a kidney from a donor with high BMI was not associated with inferior graft outcome or increased risk of graft loss. Kidneys from elderly donors did not have increased risk of graft loss, but had inferior function. Long-term follow up is essential to clarify risks associated with donation from marginal donors.

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