Older donor age is associated with higher mortality and graft loss in kidney transplant recipientsOlder Donor Age Linked to Lower Survival in Kidney Transplants

BACKGROUND: Kidney transplantation remains the optimal treatment for end-stage renal disease. With rising use of older donors to expand the organ pool, concerns have emerged about the impact of donor age on transplant outcomes. OBJECTIVES: To systematically evaluate the influence of donor age on graft and patient survival following kidney transplantation. METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Literature searches were performed in PubMed, Scopus, Embase, and Cochrane up to April 2025. Eligible studies included cohort or case-control designs reporting outcomes stratified by donor age. Outcomes assessed included death-censored graft survival, patient survival, delayed graft function, and acute rejection. Hazard ratios (HRs) were pooled using random-effects models when heterogeneity (I²) exceeded 50%. RESULTS: Seven studies involving 19,210 transplant recipients were included. Older donor age was significantly associated with an increased risk of death-censored graft loss (HR 1.73; 95% CI: 1.34-2.24) and higher patient mortality (HR 1.42; 95% CI: 1.05-1.94), particularly in the subgroup of donors aged >60 years. Heterogeneity was moderate across studies (I² = 61% for graft loss; I² = 73% for patient survival). No significant difference was observed in acute rejection rates between older and younger donor groups (OR 0.86; 95% CI: 0.60-1.23). The analysis was limited by the small number of observational studies (n = 7), with potential residual confounding and clinical heterogeneity that may affect the generalizability of the findings. CONCLUSIONS: Donor age, particularly over 60 years, is associated with poorer graft and recipients outcomes. Despite this, older donors can be acceptable with proper recipient selection and age-matching strategies. Further studies with standardized age thresholds and long-term follow-up are needed to guide allocation policy.