Predicting clinical outcome in the elderly renal transplant recipient

Background. The purpose of this study was to evaluate graft and patient sur vival in first-time kidney transplant recipients 60 years old or older, and to identify pretransplant risk factors that predict clinical outcome. Methods. We reviewed the clinical course of 206 recipients, 60 years old or older, of first kidney transplants at the University of Minnesota. Patient and graft survival were compared with 1640 patients aged 18 to 59 transpla nted during the same time period. Regression analysis was performed to iden tify risk factors that predicted a poor outcome. Results. In patients 60 years old or older, graft survival at one and five years was 86 and 60%, and patient survival at one and five years was 90 and 68%, respectively. Graft and patient survival were decreased compared with recipients aged 18 to 59, but were similar when censored for patient death as a cause of graft loss. A pretransplant history of nonskin malignancy an d vascular disease and a current smoking history were risk factors for decr eased graft and patient survival. To determine the potential impact of scre ening for low-risk patients, we evaluated graft and patient survival in pat ients age greater than or equal to 60 without these risk factors versus tho se with one or more risk factors. In the absence of risk factors, both graf t and patient survival were significantly improved compared with patients w ith these risk factors and were equivalent to that of patients aged 18 to 5 9. Conclusions. Renal transplantation is a safe and effective therapy for the older renal failure patient. In the absence of identified risk factors, gra ft survival is equivalent to that seen in younger patients.