LONG-TERM FUNCTION AND SURVIVAL OF ELDERLY DONOR KIDNEYS TRANSPLANTEDINTO YOUNG-ADULTS

Background; Traditionally, elderly donor kidneys have not been widely accepted for transplantation on the assumption of inferior performance , However, the United Network for Organ Sharing reports an increase in the number of elderly donors from less than 2% in 1982 to 24% in 1995 , This trend is commensurate with the increase of older dialysis patie nts and an overall increase in the elderly population in the United St ates (1), Optimal utilization of these kidneys is essential to overcom e the acute organ shortage, Methods. In this study, we transplanted 25 kidneys from elderly donors (ages 56-72 years) into young adult recip ients (ages 20-50 years) (group 1) over a 4-year period. We compared t he results with matched recipients of young adult donor kidneys (group 2) with regard to long-term kidney function and graft survival, A pre transplant biopsy of elderly donor kidneys was carried out and a froze n section report was obtained, Only those kidneys showing glomeruloscl erosis of less than 20% were accepted for transplantation. All cadaver ic kidneys were preserved in University of Wisconsin solution, Results , Pretransplant biopsies of elderly donor kidneys showed structural de ficits, which included glomerulosclerosis in 85%, arteriolar and/or me sangial thickening in 75%, and interstitial lymphocyte infiltration in 30%, The mean serum creatinine was 2.4+/-0.74, 2.2+/-0.56, and 2.9+/- 0.76 mg/100 ml in group 1 and 1.5+/-0.55, 2.3+/-2.24, and 1.7+/-0.62 i n group 2 at 1, 3, and 5 years, respectively, The patient survival was 92%, 92%, and 88% in group 1, and 100%, 100%, and 100% in group 2 at 1, 3, and 5 years, respectively, The graft survival was 80%, 64%, and 56% in group 1 and 100%, 96%, and 88% in group 2 at similar time inter vals, The differences in the serum creatinine and graft survival betwe en the two groups were statistically significant (P<0.05), Conclusions , Most of the elderly donor kidneys with structural deficits transplan ted into young adults provided suboptimal function and inferior long-t erm graft survival. To maximize the utilization and optimize the survi val of elderly donor kidneys, we propose transplantation of these kidn eys into age-matched recipients with similar physiological requirement s as those of donors, with regard to kidney function.