Evaluation of 84 elderly donors in renal transplantation.
BACKGROUND
The use of elderly donors (ED) and dual kidney transplantation (DKT) procedures have become common in clinical practice. A correct evaluation of kidneys from ED is crucial to avoid unsuccessful transplantation or the use of DKT when a single transplant (ST) would be equally successful. The aim of this investigation was to assess the role of renal biopsy (RB) in the assessment of kidneys from ED.


METHODS
A total of 84 ED aged > or = 60 yr were evaluated. In 19 cases, the kidneys were not used, mainly because of atherosclerotic vascular lesions. A histological score (HS) from 0 to 12 was awarded, considering the proportion of glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arterial and arteriolar narrowing. On the basis of the HS, 37 donors were selected for 40 ST and 21 for DKT, three were discarded. All recipients received triple-drug therapy based on calcineurin inhibitors, mycophenolate mofetil and steroids.


RESULTS
Primary non-function was observed in three of 40 ST and one of 21 DKT. Acute tubular necrosis occurred in 22/40 ST and in 11/21 DKT. Acute rejection occurred in 16/40 ST and four of 21 DKT. Renal function was satisfactory in both groups, with 1-yr S-Cr = 171 micromol/L and 137 micromol/L, respectively in the ST and DKT groups. One-year patient survival was 92% in ST and 100% in DKT; 1-yr graft function was 87% in ST and 95% in DKT.


CONCLUSIONS
The histological assessment of kidneys from ED enables a correct selection of kidneys for ST or DKT and prevents the transplantation of high-risk kidneys.
Rigotti
Paolo
P
Clinica Chirurgica 3, Department of Medical and Surgical Sciences, University of Padua, Italy. traprepa@unipd.it
Baldan
Nicola
N
Valente
Marialuisa
M
Scappin
Sabrina
S
Furian
Lucrezia
L
Cadrobbi
Roberto
R
Marchini
Francesco
F
Ancona
Ermanno
E
D000367:Age Factors; D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014019:Tissue Donors / Q000706:statistics & numerical data