Long-term followup of elderly donors in a live related renal transplant program

Purpose: It is a concern that elderly donors may have increased risks in th e perioperative period due to age related changes in various organ systems. Nephrosclerosis, atherosclerosis and low glomerular filtration rate may po rtend a poor graft outcome. We performed a study to determine function and outcome of kidneys from elderly donors. Materials and Methods: A retrospective analysis of our live related transpl ant program from November 1989 to December 1998 revealed that 112 donors we re older than 55 years (range 55 to 81). Of the recipients of these kidneys from elderly donors 98 had a followup of more than 2 years (group 1), and they were compared to a cohort of 87 patients whose kidney donors were youn ger than 45 years (group 2). Allograft function was evaluated by serum crea tinine and differential glomerular filtration rate was determined by (99m)t echnetium diethylenetriamine pentaacetic acid renal scan. All donors were f ollowed regularly. Results: Mean donor age plus or minus standard deviation was 57.4 +/- 4.3 a nd 31.4 +/- 7.6 years in groups 1 and 2, respectively. Mean followup plus o r minus standard deviation was 42.44 +/- 20.46 months in group 1 and 40.04 +/- 27.28 months in group 2. The 1-year graft survival rate was 91.84% and 88.51%, and the 5-year graft survival rate was 72.72% and 75.13% in groups 1 and 2, respectively. Serum creatinine was 1.5 +/- 0.65 and 1.7 +/- 1.52 m g./dl. in group 1 and 1.4 +/- 0.55 and 1.5 +/- 1.41 mg./dl. in group 2 at 1 year and last followup, respectively. Glomerular filtration rate was 37.2 +/- 11.2 and 37.3 +/- 10.7 ml. per minute in group 1 and it was 45.3 +/- 8. 6 and 47.7 +/- 11.3 ml. per minute in group 2 at 1 year and last followup, respectively. Acute rejection rate was significantly higher in group 1 (42% ) compared to group 2 (19%). Both groups were comparable in terms of infect ious episodes, antihypertensive requirement and incidence of acute tubular necrosis. There was no added morbidity for elderly compared to younger dono rs. Conclusions: In view of acute donor shortage and if properly screened, elde rly kidneys can be used without increasing the risk to donor or compromisin g graft outcome.