Eurotransplant Senior Program 'old for old': results from 10 patients

More frequently there is the need for renal transplantation of older patien ts. Against the background of an increasing number of old donors and recipi ents, Eurotransplant Leiden started the Eurotransplant Senior Program (ESP) 'old for old' in 1999. The ESP works with donors and recipients both over 65 yr. The kidneys are transplanted with short cold ischaemia time regardle ss of the human leukocyte antigen (HLA) compatibility, Compatibility of blo od groups. negative crossmatch and less than FX, cytotoxic antibodies are r equired. First experiences from 10 patients at Heinrich Heine University ho spital are reported here. The course of 10 transplanted patients is describ ed from January 1999 until November 1999 (28.4 +/- 15.8 wk). Age of donor a nd recipient, cause of dialysis and concomitant diseases from recipients, f unction of the transplanted kidney and complications are analysed. Immunosu ppression consisted initially of cyclosporin A, mycophenolic acid and stero ids. The results of these 10 patients were compared to 14 patients who were transplanted according to the ordinary Eurotransplant criteria (Eurotransp lant Kidney Allocation System) in the same period of time. Kidneys from six donors (70.5 +/- 3.3 yr) were transplanted to 10 different recipients (66. 9 +/- 2.2 yr). The control group consisted of 14 patients (47.6 +/- 14.4 yr ) who received kidneys from 14 donors (48.3 +/- 10.1 yr), One double kidney transplantation was performed in the senior group, i.e. two kidneys from a marginal donor were transplanted to one recipient ('two in one'). In the E SP group, cold ischaemia time was reduced by 5 h and mean of HLA mismatches was more than doubled. Mean length of hospitalisation of ESP and control g roups was 47.2 +/- 28.2 and 34.2 +/- 11.6 d, respectively. Intraoperatively , no complications were seen, post-operative care was performed on a normal ward. ESP patients suffered more often from delayed graft function, which led to further need for haemodialysis for 11.2 d, Finally, 9 of 10 patients acquired a satisfactory renal graft function. A total of 13 biopsies were performed in eight cases. Altogether seven acute rejections in 6 patients w ere found (four interstitial, one vascular, one interstitial + vascular, on e clinical). The 9 patients with sufficient renal graft function were disch arged with a mean serum creatinine level of 2.3 +/- 0.5 mg/dL (control: 1.9 +/- 0.8 mg/dL). Comparing these 10 recipients to a control group consistin g of 14 patients, the results are comparable and encouraging. In conclusion , the short-term results of the ESP are promising. Nevertheless, the post-o perative care requires more attention due to several complications. Though the HLA compatibility was not considered, ail rejections were coped with ef fectively. Quality of lift: was improved.