title: Deceased donor renal transplantation from older donors to increase the donor pool.
abstract: BACKGROUND
  Use of kidneys from donors aged 70 years and older is controversial. Organ shortage has led many transplant centers to accept kidneys from old, suboptimal deceased donors and make increasing use of old-for-old allocation systems. We describe our institutional experience with outcomes from transplanting deceased-donor kidneys from older donors (=70 years).
  
  
  METHODS
  20 deceased donor renal transplants (DDRTx) were performed at our center using grafts from deceased donors 70 years and older between June 2004 and September 2011. Kidneys were allocated to dual or single grafting according to pre-transplant biopsy. Mean age of recipients was 47.60 ± 11.38 years, 13 of whom were males. Mean donor age was 76.49 ± 4.9 years; 10 of whom were males. The most common cause of donor death was cerebrovascular/road traffic accidents. Mean dialysis duration pre-transplantation was 19.5 ± 6.5 months. Mean HLA (Human Leukocyte Antigens) match was 1 ± 0.8. Most common recipient diseases leading to ESRD were chronic glomerulonephritis (25%), diabetes (20%), and hypertension (20%). Post-transplant immunosuppression consisted of a calcineurin inhibitor-based regimen.
  
  
  RESULTS
  Over a mean follow-up of 2.8 ± 1.7 years, patient and graft survival rates were 75% (n = 15) and 80% ( n = 16), respectively, with a mean serum creatinine of 1.78 ± 0.56 mg/dl; 20% of the patients had biopsy-proven acute rejection episodes. A total of 25% (n = 5) patients died, mainly due to infections.
  
  
  CONCLUSIONS
  DDRTx from older donors achieves acceptable graft function with patient/graft survival, provided that organs are allocated to dual or single grafting according to pre-transplant biopsy. These findings encourage the use of this approach even in low-income countries.
authors.affiliation: Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India. drvivekkute@rediffmail.com
authors.forename: Vivek B
authors.initials: VB
authors.lastname: Kute
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: Pankaj R
authors.initials: PR
authors.lastname: Shah
authors.forename: Manoj R
authors.initials: MR
authors.lastname: Gumber
authors.forename: Himanshu V
authors.initials: HV
authors.lastname: Patel
authors.forename: Pranjal R
authors.initials: PR
authors.lastname: Modi
authors.forename: Veena R
authors.initials: VR
authors.lastname: Shah
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement