Kidney Week

Abstract: FR-PO1132

Contemporary Trends in Older and Medically Complex Living Kidney Donors Before and After KDIGO 2017 Living Donor Guidelines

Session Information

• Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Wilson, Clara, Penn Medicine, Philadelphia, Pennsylvania, United States

Clara Wilson, MD, MPH

• Zee, Jarcy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

Jarcy Zee, PhD, FASN

• Leonberg-Yoo, Amanda K., Penn Medicine, Philadelphia, Pennsylvania, United States

Amanda K. Leonberg-Yoo, MD, MS

• Amaral, Sandra, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Sandra Amaral, MD, MHS

• Bloom, Roy D., Penn Medicine, Philadelphia, Pennsylvania, United States

Roy D. Bloom, MD, MBChB

• Reese, Peter P., Vanderbilt University Medical Center, Nashville, Tennessee, United States

Peter P. Reese, MD, PhD

• Potluri, Vishnu S., Penn Medicine, Philadelphia, Pennsylvania, United States

Vishnu S. Potluri, MD, MPH

Background

In 2017, the Kidney Disease Improving Global Outcomes (KDIGO) released guidelines for the assessment of potential living donors, which encouraged transplant centers to determine their own acceptable risk thresholds for donor candidacy. We characterized contemporary trends in older and medically complex living kidney donation before and after KDIGO guidelines.

Methods

We assembled a retrospective cohort of adult living kidney donors in the US between 1/1/2010-12/31/2025 using the OPTN data. We compared baseline characteristics, including donor age and medical complexity, before and after the publication of KDIGO 2017 guidelines. Medical complexity was a composite outcome defined as the presence of any of the following pre-donation characteristics: eGFR <90 ml/min/1.73m² using CKD-EPI 2009 equation, BMI >30 kg/m2, history of hypertension, diabetes, or cigarette/tobacco use.

Results

Of 95,613 donors, 46,009 donated before and 49,604 donated after the KDIGO 2017 guidelines. Donors after 2017 versus pre-2017 were more often > 60 years (14.2 vs. 8.3%, p<0.001). There was no significant difference in the composite of medically complex living kidney donors (62.0 vs. 61.5%, p=0.068). However, donors after versus pre-2017 were more frequently hypertensive (6.6 vs. 3.6%) and had eGFR <90 ml/min/1.73 m² (29.3 vs. 26.0%), and were less frequently cigarette/tobacco users (24.4 vs. 28.2%) (p<0.001). Donors after versus pre-2017 were less frequently male (35.6 vs. 37.5%) and Black (7.8 vs. 10.6%), and more frequently Hispanic (16.4 vs. 14.3%) (p<0.001). Figure 1 suggests that the proportion of donors >60 years began to increase even before the publication of the 2017 guidelines.

Conclusion

The proportion of donors who are older continues to increase in the US, and this trend continued following the publication of KDIGO 2017 guidelines. Further studies are needed to determine center-level variation in the use of older donors and medically complex donors following publication of the KDIGO 2017 guidelines.

Funding

• Other NIH Support