Renal transplantation in recipients over the age of 60 - The impact of donor age

Background. Kidneys from older donors exhibit a series of changes character ized by glomerular, vascular, and tubular senescence. These changes may be aggravated by atherosclerosis, hypertension, or diabetes, which are highly prevalent in older individuals. Methods. We analyzed the outcome after transplantation in 230 recipients ov er the age of 60, who received transplants between February 1990 and Decemb er 1996. We assessed the 1- and 5-year patient and graft survival, the qual ity of renal function, tacrolimus levels, the incidence of rejection, and t he incidence of delayed graft function, and compared the outcomes in recipi ents of kidneys from donors over the age of 60 (group 1, n=40) with those i n recipients of kidneys from donors under the age of 60 (group 2, n=190). T here were no differences between the two groups in terms of recipient sex, race, age, and cold ischemia time. Immunosuppression was with tacrolimus an d steroids in 61% of cases; in the remainder of the patients, a third agent , either azathioprine, cyclophosphamide (for 1 week), or mycophenolate mofe til was administered as well. The median follow-up was 31.5 months (range: 1-86). Results. In recipients over the age of 60 receiving tacrolimus-based immuno suppression, overall patient survival at 1 and 5 years was 90% and 76%, and was not significantly compromised in recipients receiving a kidney from a donor over the age of 60. The overall 1- and 5-year actuarial graft surviva l was 84% and 64%; in recipients from donors over the age of 60, it was 73% and 52%, whereas in recipients of kidneys from donors under the age of 60, it was 87% and 66% (P<0.05). Most of the effect on graft survival was seen by 1 year. The mean serum creatinine was 2.6+/-2.7 mg/dl, without any diff erence between the two groups. Although the incidence of delayed graft func tion was higher in recipients of kidneys from donors over the age of 60, th is difference did not reach statistical significance. Conclusions. Although the overall outcomes of transplantation in older reci pients remain reasonable, the inferior outcomes with older donor kidneys ca ll into question proposals to utilize older donor kidneys preferentially in older recipients.