ArticleBMC geriatrics2026
Long-term kidney outcomes after living donation in older adults: clinical findings and equation-dependent eGFR estimates.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLiving kidney donation from older individuals is increasingly considered, yet, the long-term trajectories of kidney function and clinical outcomes remain insufficiently characterised. In particular, the impact of different commonly used estimation equations of the glomerular filtration rate (eGFR) on long-term risk assessment in older donors is unclear.
methodsWe analyzed 131 living kidney donors aged ≥ 60 years at the time of donation with a median follow-up of 12 years. Renal function was assessed using the CKD-EPI, FAS, and BIS1 equations at baseline, one year post-donation, and at long-term follow-up. Outcomes included substantial long-term eGFR decline (> 40%), the annual eGFR change after year 1, perioperative complications, long-term comorbidities, donor mortality, and recipient outcomes.
resultsRenal function followed a consistent biphasic pattern across all equations, with an early decline after donation followed by long-term stability. 37.0% of the donors experienced an eGFR decline > 40%, 13.4% >50%). The proportion classified below clinically relevant eGFR thresholds varied substantially depending on the eGFR equation applied, particularly one year after donation. Chronological age, including ≥ 70 years, was not associated with accelerated long-term decline. Impaired renal adaptation at one year, baseline hypertension, higher body mass index, and female sex were independently associated with steeper long-term eGFR decline. Among donors with preserved long-term eGFR (≥ 45 mL/min/1.73 m²), albuminuria identified a subgroup with less favourable renal trajectories. Relevant perioperative complications were rare (2.3%). No donor required renal replacement therapy during follow-up.
conclusionsIn carefully selected donors aged ≥ 60 years, living kidney donation is associated with stable long-term renal function and a low rate of clinically relevant eGFR decline. Long-term risk is primarily determined by biological and cardiometabolic factors rather than by age itself. The interpretation of post-donation kidney function is influenced by the estimation equation applied, highlighting the importance of longitudinal assessment rather than reliance on single threshold-based classifications.
trial registrationEudra-CT 2012-003500-12.
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