C. Vela et al., RENAL-TRANSPLANTATION IN PATIENTS MORE TH AN 60 YEARS OLD - ANALYSIS OF A 57 PATIENTS EXPERIENCE IN A SINGLE-CENTER, Nephrologie, 15(6), 1994, pp. 381-386
From April 1988 to August 1993, 57 elderly recipients more than 60 yea
rs old (mean age 64+/-3 years, 35 males, 22 females) underwent cadaver
ic renal transplantation. The pretransplant screening included immunol
ogical and viral status and urological examination; cardiovascular ris
k factors were systematically estimated by medical history, physical e
xamination, echocardiography, femoral arterial doppler, and myocardial
stress thallium imaging. A coronarography was performed if myocardial
ischemia was evidenced. Patients free of cardiovascular diseases or a
fter correction of Vascular and/or coronary lesions were included in t
he waiting list. A sequential immunosuppression regimen including azat
hioprine, prednisolone anad antilymphocyte globulins was given in all
patients. Oral cyclosporin A (5-8 mg/kg/day) was started when serum cr
eatinine level decreased to 200 mu mol/l; antilymphocyte globulins wer
e slopped when whole trough blood cyclosporin level reached 150-200 ng
/ml. After 24 months of follow-up, the patient survival rate of elderl
y recipients was significantly lower than the survival rate observed i
n patients less than 60 years old (90% vs 97%; p<0,005); the deaths we
re related to cardiovascular complications in 3 cases and to infectiou
s diseases-in 3 cases. No abdominal complications were observed in our
series. The graft survival was identical in both groups (81% vs 82% a
t 2 years), and we observed a low incidence of acute rejection (23%) i
n the elderly group. The graft function, as determined by serum creati
nine level, is significantly correlated with the donor age (p<0,05). W
e conclude that the patients more than 60 years old, free of ischemic
coronary disease or after correction of such a lesion could be safely
transplanted. We suggest that kidneys from old donors should be harves
ted and given to those elderly recipients.