AUTHOR=Savoye Emilie , Santin Gaëlle , Legeai Camille , Kerbaul François , Gaillard François , Pastural Myriam ,  the CRISTAL Registry Study Group 

TITLE=Comparison of Kidney Graft Function and Survival in an Emulated Trial With Living Donors and Brain-Dead Donors

JOURNAL=Transplant International

VOLUME=Volume 37 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.13208

DOI=10.3389/ti.2024.13208

ISSN=1432-2277

ABSTRACT=Living donation (LD) transplantation is the preferred treatment for kidney failure as compared with versus donation after brain death (DBD), but age may play a role. We compared the 1year estimated glomerular filtration rate (eGFR) after kidney transplantation (KT) for recipients of LD and DBD stratified by recipient and donor age between 2015 and 2018 in a matched cohort.The strength of the association between donation type and 1-year eGFR differed by recipient age (Pinteraction<0.0001). For LD recipients aged 40-54 years versus same-aged DBD recipients, the adjusted odds ratio (aOR) for eGFR ≥60 mL/min/1.73m 2 was 1.48 (95%CI: 1.16-1.90). For DBD recipients aged ≥ 60 years, the aOR was 0.18 (95%CI: 0.12-0.29) versus DBD recipients aged 40-54 years but was 0.91 (95%CI: 0.67-1.24) versus LD recipients aged ≥ 60 years. In the matched cohort, 4-year graft and patient survival differed by donor age and type.As compared with DBD grafts, LD grafts increased the proportion of recipients with 1-year eGFR ≥60 mL/min/1.73m 2 . Recipients aged ≥ 60 years benefited most from LD transplantation, even if the donor was aged ≥ 60 years. For younger recipients, large age differences between donor and recipient could also be addressed with a paired exchange program.