[Effect of recipient age on the clinical course of renal transplantation].
Since the immune response in older recipients has been described as weaker they may have a lower risk of rejection of a transplanted organ. Therefore a less aggressive immunosuppressive regimen should be the best option. The aim of our study was to evaluate the incidence and severity of acute rejection (AR) episodes on graft survival of older patients (> or = 60 years) and to compare them with the younger ones (< 60 years). A total of 439 kidney transplants were performed between 1/94 and 12/99 at our Transplant Unit. Clinical and immunological data, incidence and severity of AR and cause of graft loss were recorded. Patients were divided into two groups, according to age at transplantation [A (< 60, n = 342/77.9%) and B (> or = 60, n = 97/22.1%)]. The percentage of aging recipients and mean age of both donors and recipients increased through the period of study. Although the incidence of acute tubular necrosis was higher in the older group (31% vs 22.8%, pNS), the incidence of AR was also similar (31.6% vs 29.8%, pNS). The number of AR episodes per patient was 0.44 and 0.41 respectively. The incidence of AR was higher in those patients who had ATN (50% vs 19.6%), p < 0.01). The severity of AR was: Banff grade I: A (40.3%)/B (45.7%) pNS; grade II: A (44.1%)/B (48.5%) pNS; grade III: A (15.6%)/B (5.8%) pNS. One-year patient survival was 96%/91% (p < 0.001) and graft survival was 81%/78% (pNS) respectively. The age of recipient does not seem to have a significant influence on the incidence and severity of AR or on graft survival. So immunosuppression should be individualized for each patient.
Palomar
R
R
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander.
Ruiz
J C
JC
Cotorruelo
J G
JG
Zubimendi
J A
JA
de Francisco
A L
AL
Rodrigo
E
E
Sanz
S
S
Arias
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000276:immunology*; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome
D003404:Creatinine