title: Kidney and liver transplantation in the elderly.
abstract: BACKGROUND
  Transplant surgery is facing a shortage of deceased donor organs. In response, the criteria for organ donation have been extended, and an increasing number of organs from older donors are being used. For recipients, the benefits of transplantation are great, and the growing ageing population has led to increasing numbers of elderly patients being accepted for transplantation.
  
  
  METHODS
  The literature was reviewed to investigate the impact of age of donors and recipients in abdominal organ transplantation, and to highlight aspects of the fine balance in donor and recipient selection and screening, as well as allocation policies fair to young and old alike.
  
  
  RESULTS
  Overall, kidney and liver transplantation from older deceased donors have good outcomes, but are not as good as those from younger donors. Careful donor selection based on risk indices, and potentially biomarkers, special allocation schemes to match elderly donors with elderly recipients, and vigorous recipient selection, allows good outcomes with increasing age of both donors and recipients. The results of live kidney donation have been excellent for donor and recipient, and there is a trend towards inclusion of older donors. Future strategies, including personalized immunosuppression for older recipients as well as machine preservation and reconditioning of donor organs, are promising ways to improve the outcome of transplantation between older donors and older recipients.
  
  
  CONCLUSIONS
  Kidney and liver transplantation in the elderly is a clinical reality. Outcomes are good, but can be optimized by using strategies that modify donor risk factors and recipient co-morbidities, and personalized approaches to organ allocation and immunosuppression.
authors.affiliation: Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.|Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: A I
authors.initials: AI
authors.lastname: Sutherland
authors.affiliation: Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: J N M
authors.initials: JN
authors.lastname: IJzermans
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: J L R
authors.initials: JL
authors.lastname: Forsythe
authors.affiliation: Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: F J M F
authors.initials: FJ
authors.lastname: Dor
mesh_terms: D000368:Aged; D005544:Forecasting; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000941:ethics / Q000379:methods*; D016031:Liver Transplantation / Q000941:ethics / Q000379:methods*; D019520:Living Donors / Q000941:ethics / Q000706:statistics & numerical data / Q000600:supply & distribution; D011379:Prognosis; D014019:Tissue Donors / Q000706:statistics & numerical data / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data