{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:37:13Z","timestamp":1760150233345,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T00:00:00Z","timestamp":1698278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","award":["UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"],"award-info":[{"award-number":["UIDB\/00215\/2020","UIDP\/00215\/2020","LA\/P\/0064\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The global scarcity of organs for kidney transplants (KTs) has led to the increased acceptance of living donors (LDs) with minor abnormalities to increase the donor pool.. We sought to evaluate the effects of some of these LDs\u2019 clinical characteristics (older age, borderline renal function, hypertension, dyslipidemia, smoking, and obesity) on graft outcomes. Methods: We studied 352 recipients of LDKTs (1998\u20132020). Firstly, considering the recipients and KT variables, we identified relevant predictors of overall and censored graft failure (GF). Then, adjusting for these predictors, we explored LD variables as predictors of overall and censored GF in a multivariable Cox model. Results: The recipients from LD with higher eGFR (\u226590 mL\/min\/1.73 m2) had significantly better overall and censored graft survival GS) at 15 y after KT (respectively, 67 and 75% vs. 46 and 46%, p &lt; 0.001). Importantly, none of the remaining LD factors which were evaluated (hypertension, dyslipidemia, smoking, proteinuria, and obesity) were independent predictors of GF. In recipients from LDs &lt; 50 y, having an eGFR &lt; 90 was an independent predictor of overall GF [adjusted HR (95%CI) of 2.578 (1.120\u20135.795)] and censored GF [adjusted HR (95%CI) of 3.216 (1.300\u20137.959)], compared to recipients from LDs with eGFR \u2265 90. Contrarily, when donors were older, no difference in the risk of GF was observed between eGFR categories. Conclusion: In our cohort, lower pre-donation eGFR had an impact on GS only in younger LDs. An age-adjusted eGFR cutoff may be pursued for improved donor admissibility.<\/jats:p>","DOI":"10.3390\/jcm12216777","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T07:22:15Z","timestamp":1698304935000},"page":"6777","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Living Donors\u2019 Age Modifies the Impact of Pre-Donation Estimated Glomerular Filtration Rate on Graft Survival"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0312-3685","authenticated-orcid":false,"given":"Manuela","family":"Almeida","sequence":"first","affiliation":[{"name":"Department of Nephrology, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), 4099-001 Porto, Portugal"},{"name":"UMIB\u2014Unit for Multidisciplinary Research in Biomedicine, ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal"}]},{"given":"Catarina","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), 4099-001 Porto, Portugal"}]},{"given":"Jos\u00e9","family":"Silvano","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), 4099-001 Porto, Portugal"}]},{"given":"Sofia","family":"Pedroso","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), 4099-001 Porto, Portugal"},{"name":"UMIB\u2014Unit for Multidisciplinary Research in Biomedicine, ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal"}]},{"given":"Sandra","family":"Tafulo","sequence":"additional","affiliation":[{"name":"UMIB\u2014Unit for Multidisciplinary Research in Biomedicine, ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal"},{"name":"Instituto Portugu\u00eas do Sangue e da Transplantac\u0327\u00e3o, 4200-139 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6110-2102","authenticated-orcid":false,"given":"La Salete","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), 4099-001 Porto, Portugal"},{"name":"UMIB\u2014Unit for Multidisciplinary Research in Biomedicine, ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal"}]},{"given":"Miguel","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Urology, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), 4099-001 Porto, Portugal"}]},{"given":"Jorge","family":"Malheiro","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio (CHUdSA), 4099-001 Porto, Portugal"},{"name":"UMIB\u2014Unit for Multidisciplinary Research in Biomedicine, ICBAS\u2014School of Medicine and Biomedical Sciences, University of Porto, 4050-348 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: An update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int. Suppl."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1053\/j.semvascsurg.2021.02.010","article-title":"Epidemiology of end-stage kidney disease","volume":"34","author":"Gupta","year":"2021","journal-title":"Semin. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant","volume":"341","author":"Wolfe","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.1681\/ASN.2018101030","article-title":"The Terrible Toll of the Kidney Shortage","volume":"29","author":"McCormick","year":"2018","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_5","unstructured":"IPST (2023, October 10). Atividade Nacional Annual. Available online: https:\/\/www.ipst.pt\/files\/TRANSPLANTACAO\/DOACAOETRANSPLANTACAO\/Dados_Anuais_Atividade_Doacao_Transplantacao2021_versao_integral_para_publicacao.pdf."},{"key":"ref_6","unstructured":"GODAT (2023, October 10). International Report on Organ Donation and Transplantation. Available online: https:\/\/www.transplant-observatory.org\/2021-global-report-5\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1016\/S0140-6736(14)62484-3","article-title":"Living kidney donation: Outcomes, ethics, and uncertainty","volume":"385","author":"Reese","year":"2015","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1097\/00007890-200211270-00005","article-title":"Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis","volume":"74","author":"Kaplan","year":"2002","journal-title":"Transplantation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/s40620-021-01231-7","article-title":"How good is a living donor? Systematic review and meta-analysis of the effect of donor demographics on post kidney transplant outcomes","volume":"35","author":"Bellini","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.2215\/CJN.02180606","article-title":"Creating a medical, ethical, and legal framework for complex living kidney donors","volume":"1","author":"Reese","year":"2006","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1111\/j.1600-6143.2008.02361.x","article-title":"Substantial variation in the acceptance of medically complex live kidney donors across US renal transplant centers","volume":"8","author":"Reese","year":"2008","journal-title":"Am. J. Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/s-0041-1736542","article-title":"Practice Patterns for the Acceptance of Medically Complex Living Kidney Donors with Hematuria, Sickle Cell Trait, Smoking, Illegal Drug Use, or Urological Issues: A Multinational Survey","volume":"11","author":"Arabi","year":"2021","journal-title":"Avicenna J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1001\/jama.2013.285141","article-title":"Risk of end-stage renal disease following live kidney donation","volume":"311","author":"Muzaale","year":"2014","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1038\/ki.2013.460","article-title":"Long-term risks for kidney donors","volume":"86","author":"Mjoen","year":"2014","journal-title":"Kidney Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ekir.2019.10.002","article-title":"Preoperative Comorbidities and Outcomes of Medically Complex Living Kidney Donors","volume":"5","author":"Hiramitsu","year":"2020","journal-title":"Kidney Int. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1097\/TP.0000000000001770","article-title":"Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors","volume":"101","author":"Lentine","year":"2017","journal-title":"Transplantation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1097\/TP.0000000000002253","article-title":"British Transplantation Society\/Renal Association UK Guidelines for Living Donor Kidney Transplantation 2018: Summary of Updated Guidance","volume":"102","author":"Andrews","year":"2018","journal-title":"Transplantation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1111\/tri.13740","article-title":"Lower donated kidney volume is associated with increased risk of lower graft function and acute rejection at 1 year after living donor kidney\u2014A retrospective study","volume":"33","author":"Silva","year":"2020","journal-title":"Transpl. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/tri.12895","article-title":"Five myths about variable selection","volume":"30","author":"Heinze","year":"2017","journal-title":"Transpl. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"10199","DOI":"10.3389\/ti.2022.10199","article-title":"Interactions Between Donor Age and 12-Month Estimated Glomerular Filtration Rate on Allograft and Patient Outcomes after Kidney Transplantation","volume":"35","author":"Lim","year":"2022","journal-title":"Transpl. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1111\/tri.13699","article-title":"Clinical outcomes in donors and recipients of kidney transplantations involving medically complex living donors\u2014A retrospective study","volume":"33","author":"Kinoshita","year":"2020","journal-title":"Transpl. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/01.tp.0000256284.78721.ba","article-title":"Donor factors influencing graft outcomes in live donor kidney transplantation","volume":"83","author":"Issa","year":"2007","journal-title":"Transplantation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1399-0012.1997.tb00773.x","article-title":"Is matching for sex and age beneficial to kidney graft survival? Societe Francaise de Transplantation and Association France Transplant","volume":"11","author":"Busson","year":"1997","journal-title":"Clin. Transpl."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1053\/j.ajkd.2008.05.017","article-title":"Outcomes of kidney transplantation from older living donors to older recipients","volume":"52","author":"Gill","year":"2008","journal-title":"Am. J. Kidney Dis."},{"key":"ref_26","first-page":"694","article-title":"Factors affecting graft and patient survival after live donor kidney transplantation in the UK","volume":"89","author":"Fuggle","year":"2010","journal-title":"Transplantation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/TP.0b013e31821cded7","article-title":"Consideration of donor age and human leukocyte antigen matching in the setting of multiple potential living kidney donors","volume":"92","author":"Rizzari","year":"2011","journal-title":"Transplantation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1111\/j.1600-6143.2011.03552.x","article-title":"Living donor age and kidney transplant outcomes","volume":"11","author":"Noppakun","year":"2011","journal-title":"Am. J. Transpl."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/TP.0b013e31825c5940","article-title":"Kidneys from older living donors provide excellent intermediate-term outcomes after transplantation","volume":"94","author":"Balachandran","year":"2012","journal-title":"Transplantation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/ndt\/gfq383","article-title":"Effect of donor-recipient age difference on graft function and survival in live-donor kidney transplantation","volume":"26","author":"Ferrari","year":"2011","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1038\/ki.2013.444","article-title":"Summary of KDIGO 2012 CKD Guideline: Behind the scenes, need for guidance, and a framework for moving forward","volume":"85","author":"Levin","year":"2014","journal-title":"Kidney Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1681\/ASN.2019030238","article-title":"CKD: A Call for an Age-Adapted Definition","volume":"30","author":"Delanaye","year":"2019","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.2215\/CJN.02560314","article-title":"Nephron hypertrophy and glomerulosclerosis and their association with kidney function and risk factors among living kidney donors","volume":"9","author":"Elsherbiny","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1097\/00007890-200011150-00016","article-title":"Low absolute glomerular filtration rate in the living kidney donor: A risk factor for graft loss","volume":"70","author":"Norden","year":"2000","journal-title":"Transplantation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/ndt\/gft239","article-title":"Living kidney donor estimated glomerular filtration rate and recipient graft survival","volume":"29","author":"Young","year":"2014","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"180","DOI":"10.5500\/wjt.v11.i6.180","article-title":"Hypertension and obesity in living kidney donors","volume":"11","author":"Mohamed","year":"2021","journal-title":"World J. Transpl."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.phrs.2017.11.003","article-title":"Hypertension and cardiovascular risk: General aspects","volume":"129","author":"Kjeldsen","year":"2018","journal-title":"Pharmacol. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1111\/j.1600-6143.2009.02671.x","article-title":"Recipient outcomes for expanded criteria living kidney donors: The disconnect between current evidence and practice","volume":"9","author":"Iordanous","year":"2009","journal-title":"Am. J. Transpl."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/21\/6777\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:12:17Z","timestamp":1760130737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/21\/6777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,26]]},"references-count":38,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["jcm12216777"],"URL":"https:\/\/doi.org\/10.3390\/jcm12216777","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,10,26]]}}}