title: Immunosuppressive Therapy for Elderly Kidney Transplant Recipients.
abstract: OBJECTIVE
  In elderly kidney transplant (KT) recipients, the incidence of acute rejection is decreased, while that of fatal infections is increased. There are currently no guidelines for an upper age limit for KT, which is very difficult to determine. Here we examined several cases of elderly KT recipients.
  
  
  METHODS
  We evaluated 127 KT patients treated at our department between 2003 and 2012 and followed them for 3 years post-transplant. The subjects were divided into two groups by age: ≥60 years (elderly group; n = 24); and <59 years (non-elderly group; n = 103). The presence or absence of acute rejection and infection, dose of immunosuppressive drugs, trough calcineurin inhibitor level, renal function, and graft and patient survival rates were retrospectively examined.
  
  
  RESULTS
  Our basic immunosuppressive regimen was a combination of calcineurin inhibitor, methylprednisolone, mycophenolate mofetil, and basiliximab. At 1 year post-transplantation, the average tacrolimus and cyclosporine dose and trough levels were not significantly different. The mean dose of mycophenolate mofetil in the elderly group at 1 year post-transplantation was significantly lower than that of the non-elderly group. The incidences of cytomegalovirus infection and acute rejection during follow-up did not differ significantly between groups. There were no significant differences in creatinine level between the two groups. In the elderly group, the graft survival rates at 1 and 5 years were 100% and 95.4%, respectively, while those in the non-elderly group were 98.1% and 92.5%, respectively.
  
  
  CONCLUSIONS
  Using our current immunosuppressive protocol, the outcomes of patients in the elderly group were considered acceptable.
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan. Electronic address: hitoiwa@tokyo-med.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Iwamoto
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Konno
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tomita
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ueno
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yokoyama
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kihara
authors.affiliation: Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kawachi
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D065095:Calcineurin Inhibitors / Q000097:blood / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007564:Japan / Q000453:epidemiology; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D066027:Transplant Recipients
chemical_list: D000911:Antibodies, Monoclonal; D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D009173:Mycophenolic Acid; D008775:Methylprednisolone