UTILIZATION OF THE OLDER DONOR FOR RENAL-TRANSPLANTATION

BACKGROUND: The persistent shortage of ideal donor organs has resulted in increased transplantation of kidneys from older donors (age > 60 y ears). The overall experience with this donor subgroup indicates decre ased graft survival. METHODS: The records of 413 renal transplants per formed between July 1991 and July 1995 were reviewed in a retrospectiv e fashion to determine those patients who had received a cadaveric (CT > 60; n = 17) or living donor (LT > 60; n = 7) renal transplant from an older donor. Control groups consisted of randomly selected patients who received cadaveric (CT < 50; n = 20) or living related (LT < 50; n = 20) renal transplants from donors less than 50 years of age. RESUL TS: In the CT > 60 group, 1-year graft survival was 57.4%, significant ly less than in those of the LT < 50 (100%), LT > 60 (100%), and CT < 50 (89%) groups. Mean recipient serum creatinine in the CT > 60 group was twofold greater than that of other groups at 1, 6, and 12 months f ollowing transplantation, Cold ischemia time and creatinine clearance correlated highly with graft survival. Stepwise regression analysis sh owed creatinine clearance to be the sole independent predictor of graf t survival. A calculated donor creatinine clearance < 50 mL/minute was associated with ultimate graft loss. CONCLUSION: Age alone should not be an exclusion criterion to renal organ donation. When considering t he older renal donor, creatinine clearance should be included within t he decision algorithm. (C) 1996 by Excerpta Medica, Inc.