C. Bösmüller, R. Öllinger, C. Iannetti-Hackl, F. Cakar-Beck, W. Mark, R. Margreiter

Abstract

Background: We retrospectively analyzed the results of totally 6 patients who received a renal graft from >80 years aged donors in Eurotransplant senior program.

Patients and methods: Between May 1999 and March 2007 a total of 70 kidney transplants from donors aged over 65 years were given to recipients over 65 at our center. Six out of them, mean age 66,0 (65-68) years, received organs from donors, mean age 81,3 years, who had no history of hypertension, diabetes, smoking or obesity, and a latest mean serum creatinine of 0,7 (0,7-0,9) mg/dL. Baseline biopsy of four grafts showed in two of them a 20% / 8% glomerulosclerosis and mild tubular atrophy but otherwise normal histology. The mean cold storage time was 11:35 (7:19 – 16:02) hours. The initial immunosuppression was CNI-free in five patients consisting of an IL-II receptor antibody + MMF + Steroids. Cyclosporine A was started at day 8,2 (7-10), when graft function had stabilized. In one patient each Belatacept or CyA were given from the beginning, according to a study protocol.

Results: The ATN-rate was 2/6. Altogether 2 biopsy-proven acute rejection episodes were reversed by pulsed steroids. Apart from one Polyomavirus infection which led to graft loss at month 9, all other infectious complications, mostly urinary tract infections, were treated successfully. Other postoperative complications were caused by preexisting comorbidities and could be managed. One patient died from an intracerebral B-cell Lymphoma at month 27 with a functioning graft. The 2-years patient / graft survival was 100 / 83,3%. The actual mean serum creatinine of the survivors was 1,6 (0,7-2,4) mg/dL.

Conclusion: We conclude that good results can be achieved with kidneys from donors over 80 years without cardiac risk factors and good renal function and if nephrotoxic drugs are used with caution.

Key words: kidney transplantation, old for old program, old donors

Dr. Claudia Bösmüller

Abtlg. für Transplantionschirurgie

Universitätsklinik

Anichstr.35

A-6020 Innsbruck

Österreich

E-Mail: claudia.boesmueller@bitte-keinen-spamuki.at