A case of chronic renal allograft failure by effects of elderly donor

We experienced a case of chronic renal allograft failure from an elderly donor. A 23-year-old man received living-related transplantation in 1998. The donor was his father, 66 years old and 69 kg body weight. The recipient was 88 kg and the cause of the renal failure was IgA nephropathy. The graft function decreased 2 months after transplantation. One year later, proteinuria and haematuria developed. Six months later, when the creatinine rose to 2.5 mg/dL, a renal transplant biopsy was performed. Characteristic microscopic features were: diffuse segmental to global glomerulosclerosis, hypertrophy of non-sclerotic glomerulus, tubular atrophy, arteriolar hyalinosis, interstitial lymphocytic infiltration with tubulitis and anti-IgA deposition on glomeruli. The pathological diagnoses were recurrent IgA nephropathy, acute rejection and chronic cyclosporin nephrotoxicity. Diffuse glomerulosclerosis as well as glomerular hypertrophy might be the end result of hyperfiltration, which was a consequence of a small number of functioning nephrons. The old age of the donor and the heavy body weight of the recipient could be risk factors for this case.