[Organ transplantation in old age]

The aging of organ donor and recipient populations is raising new issues in kidney transplantation. Transplantation is generally considered the best treatment for end-stage renal disease (ESRD), but this remains to be demonstrated in elderly populations (> 65 years). The main issues can be summarized as follows: the population of geriatric patients with ESRD is expanding rapidly, and more data are needed to determine whether transplantation confers a survival advantage, as in younger populations; the critical shortage of cadaveric donors is leading to the use of older kidneys, which may not last as long; and increasing numbers of older individuals wish to donate a kidney to a relative, and particularly to their spouse. Several specific programs have been launched, including the Eurotransplant Senior program, the Old for Old program and the Two Marginal Kidneys for One Recipient program. Further research is needed to evaluate the efficacy and safety of these new applications. Nephrologists and urologists caring for elderly populations with ESRD need specific geriatric training.