Renal transplantation in patients over 65 years of age: no more a contraindication but a growing indication.
BACKGROUND
Worldwide organ shortage and the increasing age of end-stage renal disease patients demanding a graft have prompted extensive use of marginal donors. The "old-for-old" allocation has been proposed for the elderly. The aim of this study was to evaluate the results of a policy of free acceptance into the waiting list of recipients older than 65 years.


METHODS
From 1987 to 2004 70 patients whose mean age was 67.4 +/- 2.8 years, underwent an extensive pretransplant evaluation including cardiac studies. Immunosuppression was based upon low-dose steroids, and cyclosporine (50%) or tacrolimus (44%).


RESULTS
Patient and graft survival at 1, 3, 5, and 10 years were 85%, 78.5%, 75%, 50%, and 80%, 74%, 70%, 36%, respectively. Death occurred in 17/70 (24%), 14 of whom had a functioning graft. The causes of death were 30% cancer, 23% cardiovascular, 23% sepsis, 12% cerebrovascular hemorrhage, 12% meningitis. The acute rejection (AR) rate was 18.6%. The causes of graft loss were: 71% patient death, 4% irreversible AR, 4% vascular thrombosis, and 21% chronic allograft dysfunction. The main complications were: 52% prostatic hypertrophy, 40% urinary tract infections, 8.6% diabetes, 11% pneumonia, 10% cardiovascular diseases, 7% urological complications, 8% abdominal pathology, 6% acute pyelonephritis, 8% non-skin cancer.


CONCLUSIONS
Despite the increased vulnerability of the elderly, they should not be excluded a priori from renal transplantation. Extensive pretransplant screening, mainly cardiovascular, and a tailored immunosuppression are two crucial issues. The moderate rate of AR suggests that these patients do not have an impaired immunocompetence as far as acute rejection is concerned.
Segoloni
G P
GP
Nephrology, Dialysis and Transplantation Unit, Chair of Nephrology, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
Messina
M
M
Giraudi
R
R
Leonardi
G
G
Torta
E
E
Gabrielli
D
D
Ferrari
A
A
Pellu
V
V
Tattoli
F
F
Fop
F
F
D000328:Adult; D000367:Age Factors; D000368:Aged; D000075202:Contraindications; D006085:Graft Survival / Q000502:physiology*; D006334:Heart Function Tests; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality; D008875:Middle Aged; D016019:Survival Analysis; D014019:Tissue Donors / Q000600:supply & distribution
D007166:Immunosuppressive Agents