Implication of Donor–Recipient Age Gradient in the Prognosis of Graft Outcome After Deceased-Donor Kidney Transplantation

Abstract Purpose Successful kidney transplantation leads to greater survival and improved quality of life for patients with end-stage renal disease. Among the most important influences on graft outcomes is donor age. We evaluated the relationships between the donor–recipient age gradient (DRAG) and the graft outcomes after deceased-donor kidney transplantation (DDKT). Methods From February 1995 to March 2011, a consecutive series of 526 adult DDKT recipients were analyzed. DRAG values were divided into two groups (negative versus positive years) and then four groups (≤−21, −20 to −1, 0 to 20, and ≥21 years). Results Median age of donors and recipients were 39 (range, 1–75) and 41 (range, 18–74) years, respectively. The degree of DRAG was not associated with episodes of allograft rejection. High or low DRAG had no effect on posttransplant serum creatinine levels or estimated glomerular filtration rates. However, negative levels of DRAG, particularly less than −20 years, were significantly correlated with superior 10-year death-censored graft survival (86.4% and 83.1% vs 72.2% vs 53.9%; overall P = .031), but not increased overall graft or patient survival. Conclusion This study demonstrated that DRAG is a prognostic indicator of long-term graft outcomes after DDKT.