Impact of donor kidney function and donor age on poor outcome of living‐unrelated kidney transplantation ( KT ) in comparison with living‐related KT

Living‐unrelated donors ( LURD ) have been widely used for kidney transplantation ( KT ). We retrospectively reviewed 779 patients who underwent living‐donor KT from 2000 to 2012, to compare outcomes of 264 KT from LURD and 515 from living‐related donors ( LRD ), and to identify risk factors for living KT . Median follow‐up was 67 months. Mean donor age, total human leukocyte antigen ( HLA ) mismatches, and HLA – DR mismatches were higher, and mean estimated glomerular filtration rate (e GFR ) was lower in LURD . Acute rejection ( AR )‐free survival (p = 0.018) and graft survival (p = 0.025) were lower for LURD than LRD , whereas patient survival rate was comparable. Cox regression analysis showed HLA – DR mismatches (OR 1.75 for one mismatch; OR 2.19 for two mismatches), recipient age ≤ 42 yr, and donor age > 50 yr were significant risk factors for acute rejection. For graft survival, AR and donor e GFR ( OR 1.90, p = 0.035) were significant. We also identified significant impact of recipient age > 50 yr and diabetes for patient survival. However, KT from LURD was not a significant risk factor for AR (p = 0.368), graft survival (p = 0.205), and patient survival (p = 0.836). Our data suggest that donor e GFR and donor age are independent risk factors for clinical outcomes of living KT , which can be related with poor outcome of KT from LURD .