LONG-TERM FOLLOW-UP OF KIDNEYS TRANSPLANTED FROM ELDERLY CADAVERIC DONORS

This report examines the long-term results obtained in 50 patients tra nsplanted between 1977 and 1990 with kidneys from cadaveric donors age d 55-70 (median 59) years. The recipients comprised 27 men and 23 wome n aged 8-68 (median 42) years. In all, 20 patients (40%) had end-stage renal disease on the basis of glomerulonephritis, whereas 8 (16%) wer e diabetic. Immunosuppression was induced with antilymphocyte globulin and maintained with azathioprine and prednisone in all patients in ad dition to cyclosporine in the 35 patients transplanted since 1985. Imm ediate graft function occurred in 18 patients (36%), and 36 patients ( 72%) were off dialysis at 1 year posttransplant. Altogether, 25 patien ts (50%) had functioning grafts at 5 years posttransplant, and at up t o 13 years of follow-up (mean 5.8 years), 22 patients (44%) are off di alysis and their serum creatinine levels range from 0.8 to 3.8 mg/dl ( mean 2.0 mg/dl). In all, 12 patients (24%) expired from 2 months to 15 .5 years posttransplant (mean 4.3 years), and 5 of these patients died with functioning grafts. These 5 deceased recipients and the 22 who r emain alive with functioning grafts had a mean antigen match of 2.27 w ith their donors. The other 23 patients whose, grafts failed had a mea n antigen match of 2.13 (P = 0.77). The 15 recipients who were transpl anted prior to the cyclosporine era had lower 1- and 5-year allograft survival rates of 67% and 47%, respectively, as compared with their co unterparts, who took cyclosporine-based immunosuppression (74% and 51% , P = 0.58 and 0.76, respectively). Likewise, the 32 recipients with d elayed graft function had lower 1- and 5-year allograft survival rates of 66% and 47%, respectively, as compared with the group with immedia te graft function (83% and 56%, P = 0.18 and 0.56, respectively). We c onclude that acceptable long-term patient and graft survival may be ac hieved by transplanting these organs and that the degree of HLA matchi ng does not affect their outcome significantly. Patients with immediat e allograft function also tended to do better over the long term, Alth ough cyclosporine-based immunosuppression was advantageous within 1 ye ar of transplant, its beneficial effect was less marked 5 years out. D ue to previously high discard rates of organs from marginal donors [5] , there has been little opportunity for longterm follow-up of kidneys transplanted from elderly individuals, whether living-related or cadav eric donors. In view of the well-established decline in renal function with advancing age [7], more studies of this sort are needed. Further more, as the population ages, more elderly people are being considered as kidney transplant recipients as well as organ donors. This demogra phic reality, in addition to the chronic shortage of transplantable or gans, necessitates a critical appraisal of organ transplantation to an d from the elderly. We have previously reviewed a cohort of patients t ransplanted with kidneys from cadaveric donors aged 55-70 years [11], and have now followed this group for a minimum of 5 years posttranspla nt, with the exception of one recipient, who was lost to follow-up. Th e long-term results we obtained in these patients are described below.