Elderly donors and renal transplantation

Efforts to increase the donor pool of available organs have resulted in som e unconventional kidney transplantation procedures. One of these is the use of elderly donors for both living and cadaver kidney transplantations. The aim of this study was to review our experience with kidney transplants fro m living elderly donors. During a period of 10 years, 70 living renal trans plantations were performed. In 32 transplants the age of the donor was abov e 65 years (mean 69 +/- 4 years, range: 65 to 81 years) and in 10 of these 32 transplants the age of the donor was over 70 years. The survival rate wa s compared with that of 38 transplants from younger donors (mean age 51 +/- 6 years, range: 24 to 59 years). The time to cold and warm ischemia, the p reservation procedure and time to anastomosis of blood vessels were compara ble in both groups of donors. Immunosuppression included a sequential quadr uple protocol, using thymoglobulin (ATG), prednisolone (PRED), azathioprin (AZA) and cyclosporin A (CsA), which replaced ATG/PRED after day seven. A t riple drug maintenance therapy (AZA, PRED, CsA) was used in all recipients. Kaplan-Meier survival curves at 1, 3 and 5 years showed that graft surviva l was 88%, 79% and 64% respectively for grafts from the advanced age donor group and 92%, 82% and 68% respectively for grafts from the younger donor g roup. The difference was slightly statistically significant (p < 0.05). Fun ctioning ot the graft was delayed in six patients who had received grafts f rom elderly donors and in one patient who had received a graft from a young donor. Despite worse results in transplantation with grafts from elderly d onors, we consider this population as an important source of kidneys, which might help solve the present organ shortage, especially in our region. (C) 2000 Editions scientifiques et medicales Elsevier SAS.