The association of donor and recipient age with graft survival in paediatric renal transplant recipients in a European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplantation Association Registry study

Nephrol Dial Transplant. 2017 Nov 1;32(11):1949-1956. doi: 10.1093/ndt/gfx261.


Background: The impact of donor age in paediatric kidney transplantation is unclear. We therefore examined the association of donor-recipient age combinations with graft survival in children.

Methods: Data for 4686 first kidney transplantations performed in 13 countries in 1990-2013 were extracted from the ESPN/ERA-EDTA Registry. The effect of donor and recipient age combinations on 5-year graft-failure risk, stratified by donor source, was estimated using Kaplan-Meier survival curves and Cox regression, while adjusting for sex, primary renal diseases with a high risk of recurrence, pre-emptive transplantation, year of transplantation and country.

Results: The risk of graft failure in older living donors (50-75 years old) was similar to that of younger living donors {adjusted hazard ratio [aHR] 0.74 [95% confidence interval (CI) 0.38-1.47]}. Deceased donor (DD) age was non-linearly associated with graft survival, with the highest risk of graft failure found in the youngest donor age group [0-5 years; compared with donor ages 12-19 years; aHR 1.69 (95% CI 1.26-2.26)], especially among the youngest recipients (0-11 years). DD age had little effect on graft failure in recipients' ages 12-19 years.

Conclusions: Our results suggest that donations from older living donors provide excellent graft outcomes in all paediatric recipients. For young recipients, the allocation of DDs over the age of 5 years should be prioritized.

Keywords: epidemiology; graft survival; paediatric nephrology; transplantation.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Europe
  • Female
  • Graft Rejection / mortality*
  • Graft Survival
  • Humans
  • Kaplan-Meier Estimate
  • Kidney / surgery
  • Kidney Diseases / mortality
  • Kidney Diseases / surgery*
  • Kidney Transplantation*
  • Living Donors
  • Male
  • Proportional Hazards Models
  • Registries
  • Renal Dialysis
  • Risk Factors
  • Transplant Recipients
  • Young Adult