Introduction: The increasing demand for organs has led many institutions to accept elderly patients onto their living donor programmes. However no large UK based datasets exist to assess the scope of the practice and patient outcomes. It is therefore unclear if an upper age limit to donation should exist.

Methods: Details of all 10,900 patients undergoing living kidney donation (LDN) in the UK from 2000 – 2013 were obtained. Patients were stratified into under 65 and 65+ years populations. Baseline demographics, co morbidity burden, nature and incidence of complications and their severity, renal function and proteinuria were all analysed using univariate tests of association.

Results: 586 (5.8%) over 65s underwent LDN during the 13 year period. Elderly LDN increased from 2.29% in 2000 to 11.08% of the total cohort in 2013 (p=0.000). Older donors were more likely to be white (96 v 86% p=0.00) have a lower deprivation score (mean IMD14.9 v 21.3 p=0.001) and be hypertensive (15.8% v 7.12% p=0.000), but had an otherwise lower comorbidity burden (ASA 2+) (8.19% v 13.32% p=0.00). BMI, sex and operative factors were similar in both groups. The occurrence of minor (Clavien 1/2:8.9 v 10.1% p=0.353) and major (Clavien 3+: 2.39 v 1.76% p=0.263) complications were also similar. Mean hospital stay was equivalent (mean 4.63 v 4.42 days, p=0.12). Incremental rises in systolic blood pressure (3.62 v 1.56mmHg p=0.02) and creatinine (36.7 v 30.4 ¯o;mol p=0.000)1 year post donation were all greater in the over 65s. Incidence of new onset proteinuria at 1 year was similar (3.41 v 3.51% p=0.433).

Discussion: Elderly donors comprise a significant and increasing proportion of the kidney organ donor pool. Older donors are being chosen based on more conservative parameters of co-morbidity and come from more affluent backgrounds. Perioperative morbidity is similar to their younger counterparts. Postoperative measures of cardiovascular risk are also within acceptable Iimits. Continued and increasing use of elderly donors is acceptable, however further data on recipient outcomes assessing the impact on graft function is required.

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