Kidney transplantation from donors aged 65 years or more as single or dual grafts.
OBJECTIVE
The organ shortage and aging donor population force transplant centers to accept donors previously considered unusable for kidney transplantation. We report the experience of two Italian transplant centers with single (SKTx) and dual (DKTx) kidney transplantation from donors aged 65 years or more.


METHODS
The study population comprised 75 SKTx (mean donor age 70.5 years) and 28 DKTx (mean donor age 75.0 years). Kidneys from donors with a calculated admission creatinine clearance <50 mL/min, a Karpinski's score on kidney biopsy between 5 and 7, or both were allocated to DKTx. Grafts with better function or lower biopsy scores were employed for SKTx.


RESULTS
Delayed graft function occurred in 45.3% of SKTx and in 39.3% of DKTx. After a mean follow-up period of 30.0 +/- 19.5 months, the acute rejection rate was 24.0% in SKTx and 7.1% in DKTx. Mean serum creatinine was 1.8 +/- 0.9 and 1.8 +/- 1.3 mg/dL in SKTx, and 1.8 +/- 1.6 mg/dL and 1.3 +/- 0.2 mg/dL in DKTx at 1 and 5 years, respectively. Patient survival was 93.3% and 91.2% in SKTx, and 92.9% and 92.9% in DKTx at 1 and 5 years, respectively. Graft survival was 92.0% and 88.3% in SKTx, and 89.3% and 89.3% in DKTx at the same time intervals. Keeping preservation time below 16 hours and avoiding calcineurin inhibitors were both associated with improved graft survival and function.


CONCLUSIONS
Careful donor selection, short preservation time, and tailored immunosuppression allow safe and efficient use of elderly donor kidneys.
Boggi
U
U
Department of Surgery and Transplantation, University of Pisa, Pisa, Italy.
Barsotti
M
M
Collini
A
A
Bernini
M
M
Vistoli
F
F
Paleologo
G
G
Bianchi
A M
AM
Tregnaghi
C
C
Nerucci
B
B
Ruggieri
G
G
Carmellini
M
M
Rizzo
G
G
Mosca
F
F
D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007558:Italy; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality / Q000502:physiology*; D008297:Male; D018579:Patient Selection; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D003404:Creatinine