Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: a study by the ERA-EDTA Registry

Nephrol Dial Transplant. 2020 Mar 1;35(3):534-543. doi: 10.1093/ndt/gfy268.


Background: Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.

Methods: We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.

Results: The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1-24.9]} and young [15.3% (95% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9-41.5)] and young [29.2% (95% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44-0.68)] and 40% [young aHR 0.60 (95% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00-1.04)] or 1% [young aHR 1.01 (95% CI 1.00-1.01)] increase in the 10-year risk of death.

Conclusions: Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.

Keywords: ERA-EDTA Registry; deceased donor; donor age; epidemiology; kidney transplantation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Death
  • Europe / epidemiology
  • Female
  • Graft Rejection / epidemiology
  • Graft Rejection / mortality*
  • Graft Survival*
  • Humans
  • Incidence
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / mortality*
  • Male
  • Middle Aged
  • Prognosis
  • Registries / statistics & numerical data*
  • Survival Rate
  • Tissue Donors / statistics & numerical data
  • Tissue Donors / supply & distribution*
  • Transplant Recipients
  • Young Adult