Donor age and recipient age.
Donor age. 1. Kidneys from older donors led to markedly lower graft survival than kidneys from younger donors. The 1-year first cadaver donor graft survival rates were 80% for recipients receiving kidneys from 16-year-old donors, 70% from 50-year olds and 57% from 65-year-old donors. This means that 1-year graft survival decreased 10% by donor age 50 and 23% by donor age 65. 2. The trend toward lower graft survival with older donors was most noticeable after 1985, suggesting that CsA treatment was primarily responsible for the effect. 3. Twelve percent of kidneys from donors over age 50 never functioned while the nonfunction rate of 17- to 30-year-old donor kidneys was only 2%. Forty-six percent of kidneys from younger donors functioned within 3 days, whereas 26% functioned in 3 days if they came from donors who were older than 50. 4. The tendency to use older donors has gradually increased in the past 10 years. Donors over 50 years of age comprised 5% of the donors in 1978 and rose to 10% by 1987. 5. Transfusions, HLA-B,DR mismatches, and causes of failure were not related to donor age. 6. In transplants performed in the last 10 years, donor age did not play a significant role in either patient or graft survival. Whether or not this will hold true for more recent CsA-treated transplants remains to be seen. Recipient age. 1. The most significant effect of recipient age for patients transplanted since 1983 was on patient survival: it dropped from 100% for 6- to 7-year-old recipients to 86% for 68- to 71-year olds. 2. There is an increased tendency to transplant patients older than 50. The number rose from 14% in 1978 to 25% in 1987. 3. A very strong association was noted between advancing recipient age and corresponding decrease in immunologic failures and increase in nonimmunologic failures. Immunologic responsiveness to allografts decreased with age, though failures from nonimmunologic causes increased with age. 4. Patients with no transfusions had increasingly higher graft survival with age: 63% 1-year graft survival for patients up to 20 years old and 73% for those over 50 which was consistent with the above findings. Transfusions led to 1-year graft survival of about 76% in all groups. Thus, transfusions had less effect in older recipients.(ABSTRACT TRUNCATED AT 400 WORDS)
Takemoto
S
S
Terasaki
P I
PI
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion; D002102:Cadaver; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005500:Follow-Up Studies; D006082:Graft Enhancement, Immunologic; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D008875:Middle Aged; D015996:Survival Rate