Trends, Outcomes, and Evaluation of the Older Living Kidney Donor

Purpose of Review: We aim to review trends, donor and recipient outcomes, and considerations in the evaluation of older living kidney donors (LD). Recent Findings: Older donors comprise a small but growing proportion of LDs. Aging is associated with nephrosclerosis, nephron loss, and a physiologic decline in kidney function. Importantly, living donor outcomes are favorable, with older LDs having similar mortality to age-matched healthy older non-donors, a lower lifetime risk of ESKD than younger LDs, and preserved quality of life. Allograft survival of LDKT from older LDs is also acceptable, and recipient survival is better than many DDKT recipients. The evaluation of older LD candidates should include careful assessment and counseling regarding pre- and post-donation kidney function and cardiovascular risks. Summary: Older LDs represent a more complex but potentially acceptable option for living donor kidney transplantation. Ongoing work should continue to optimize the evaluation process, care, and long-term follow-up of older LDs and their transplant recipients.