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International Journal of Surgery

Incompatible living-donor kidney transplants tied to longer survival

Ten-year survival was 86.3% after incompatible living-donor transplants versus 56.8% with standard waitlist care in matched patients aged 60 or older.

Paper by Hwa-Hee Koh, Sangwan Kim, Ara Cho, 7 more authorsSangil Min · Ajou University
A full dark blue-green kidney cross-section sits beside many upright figures; a smaller, thin-rimmed gray kidney has fewer figures nearby.
Cohort study of 1,819 patients aged ≥60 years, 10-year, against the CWS groupInterventions

Limit: Propensity score matching cannot eliminate all differences between the treatment and waitlist groups

Edited by Boris Djordjevic · AgingResearch.News

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A retrospective cohort study included 1,819 kidney-transplant candidates aged 60 or older with end-stage kidney disease. Of these, 210 received living-donor kidneys despite incompatible blood groups or immune-system markers, after treatment intended to reduce immune incompatibility. The other 1,609 followed the standard deceased-donor waiting-list pathway: 233 received transplants and 1,376 remained waiting. Researchers matched patients with similar measured characteristics.

In the matched comparison, 10-year survival was 86.3% after incompatible living-donor transplantation versus 56.8% under standard waitlist care. Patient survival was comparable between recipients of incompatible living-donor kidneys and deceased-donor kidneys. Five-year survival of the transplanted kidney was 93.9% versus 78.2%, respectively. Acute rejection—an immune attack on the kidney confirmed by biopsy—occurred in 22.9% versus 29.6%; the rates were similar.

Why it matters

Older people with end-stage kidney disease face prolonged transplant waits and a risk of dying while waiting. The study informs decisions about which living-donor options to consider when immune incompatibility presents a barrier.

Caveats

This observational study cannot establish that the transplant strategy caused the survival difference, because matching cannot eliminate all differences between groups. The findings concern waitlisted adults aged 60 or older with end-stage kidney disease, not all older adults.

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