RATIONALE & OBJECTIVE The benefits of kidney transplantation compared with treatment with dialysis, including in older adults, are primarily limited by the number of donated kidneys. We studied the potential to expand the use of older living kidney donors. STUDY DESIGN Secondary analysis of the Berlin Initiative Study, a population-based cohort. SETTING & PARTICIPANTS 2,069 adults aged≥70 years in Germany. EXPOSURE Age and sex. OUTCOME Suitability for living donation assessed by the absence of kidney-related exclusions for donation including albuminuria and low estimated glomerular filtration rate (eGFR) as well as absence of other medical exclusions. Willingness for living and deceased kidney donation assessed by participant survey. ANALYTICAL APPROACH Descriptive analysis. RESULTS Among the 2,069 participants (median age 80 years, 53% women, median eGFR 63mL/min/1.73m2), 93% had≥1 medical contraindication for living donation at study entry unrelated to eGFR or albuminuria. Using 2 published eGFR and albuminuria thresholds for donor acceptance, 38% to 54% of participants had kidney-related exclusions for donation. Among the 5% to 6% of participants with neither medical nor kidney-related exclusions for living donation at baseline, 11% to 12% remained suitable for donation during 8 years of follow-up. Willingness for living or deceased donation was high (73% and 60%, respectively). LIMITATIONS GFR was not measured, and medical exclusions unrelated to eGFR and albuminuria were assessed using a cohort database complemented by claims data. CONCLUSIONS One in 20 older adults were potentially suitable for living kidney donation, and willingness for living donation was high. Further studies are warranted to define the feasibility of expanding living kidney donation among older adults. PLAIN-LANGUAGE SUMMARY Although potentially beneficial, kidney transplantation remains infrequent among older adults aged≥70 years with kidney failure. Study evaluated the potential to increase living kidney donation among older adults, including their medical suitability as well as willingness to donate. Among 2,069 community-dwelling older adults (median age 80 years), 5% to 6% had no exclusion to donation. Among these individuals, 11% to 12% remained suitable for donation during 8 years of follow-up. Most exclusions were not related to eGFR and albuminuria. Willingness to living donation was high (73%). These findings highlight the potential benefits from expanding the pool of transplantable kidneys through the use of living donation in older adults.

中文翻译：

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老年人的医疗适用性和活体肾脏捐献的意愿。


基本原理和目标 肾移植与透析治疗相比，包括对老年人的好处，主要受到捐赠肾脏数量的限制。我们研究了扩大老年活体肾脏供体使用的潜力。研究设计 柏林倡议研究的二次分析，一个基于人群的队列。地点和参与者 德国有2,069名年龄≥70岁的成年人。曝光 年龄和性别。结果 通过不存在与肾脏相关的捐献排除（包括白蛋白尿和低估计肾小球滤过率 （eGFR） ）以及没有其他医学排除来评估活体捐献的适用性。通过参与者调查评估活体和已故肾脏捐献的意愿。分析方法 描述性分析。结果 在 2,069 名参与者 （中位年龄 80 岁，53% 女性，中位 eGFR 63mL/min/1.73m2） 中，93% 在研究开始时有 ≥ 1 与 eGFR 或白蛋白尿无关的活体捐献医学禁忌症。使用 2 个已发表的 eGFR 和白蛋白尿阈值来接受供体，38% 至 54% 的参与者存在肾脏相关捐献排除。在 5% 至 6% 的参与者中，基线时既没有排除医学也不排除肾脏相关活体捐献，11% 至 12% 的参与者在 8 年的随访期间仍然适合捐献。活体或已故捐献的意愿很高 （分别为 73% 和 60%）。局限性 未测量 GFR，使用队列数据库评估与 eGFR 和白蛋白尿无关的医学排除，并辅以索赔数据。结论 每 20 名老年人中就有 1 名可能适合活体肾脏捐献，活体捐献意愿高。 需要进一步的研究来确定在老年人中扩大活体肾脏捐献的可行性。通俗易懂的语言摘要 尽管可能有益，但在 70 岁的肾衰竭老年人中，肾移植仍然不常见≥。研究评估了增加老年人活体肾脏捐献的潜力，包括他们的医疗适宜性以及捐献意愿。在 2,069 名社区老年人（中位年龄 80 岁）中，5% 至 6% 的人没有排除捐献。在这些个体中，11% 至 12% 在 8 年的随访期间仍然适合捐献。大多数排除与 eGFR 和白蛋白尿无关。活体捐献的意愿很高 （73%）。这些发现强调了通过在老年人中使用活体捐献来扩大可移植肾脏库的潜在益处。