Elderly donor kidney transplant: factors involved in graft survival

To evaluate whether control of risk factors associated with worse results has improved graft survival, with respect of renal function quality and other factors influencing graft survival: recipient age, immunosuppressive therapy, cold ischemia time, acute tubular necrosis (ATN), acute rejection episodes (ARE) and 1-month creatinine levels.

Retrospective review of 147 patients who underwent kidney transplant between 1995 and 2001. Inclusion criteria were donor and recipient age older than 60 years, first renal transplant, follow-up period longer than 12 months, donor creatinine clearance higher than 75 mL/min, and less than 20% glomerulosclerosis observed in donor renal biopsy.

Graft survivals were 87%, 83%, 78%, and 70% at first, second, third, and fifth year after transplantation, respectively. Mean serum creatinine levels were 2.3 mg/dL and mean follow-up time, 46 months. Multivariate analysis using a Cox regression model identified donor age, ARE, and serum creatinine levels 1 month after surgery as independent variables affecting graft survival. Recipient age, immunosuppressive therapy, and serum creatinine levels at 1 month after surgery were predictive variables of recipient survival.

Renal transplantation is an accepted therapeutic option in elderly patients with chronic renal insufficiency, if both donor and recipient are carefully selected.