Renal transplantation in recipients over 65 years old

Older patients on hemodialysis have become candidates for renal transplantation, particularly in the period of increasing numbers of marginal donors. The purpose of this study was to evaluate short-term and long-term results of renal transplantation among recipients ≥65 years old for comparison with these in younger patients.

We retrospectively studied 1,796 renal transplantations performed between June 1991 and May 2010, dividing the sample into 2 groups: ≥65 years old (n = 89) versus <65 years old (n = 1,707).

The mean ages were 42.17 and 67.45 years for the younger and older groups, respectively. Time of pretransplantation dialysis was significantly greater among the older group (52.76 vs 47.69 mo). There were no differences between the 2 groups regarding donor age, donor renal function, or cold ischemia times. After a mean follow-up of 73.37 versus 39.73 months for the younger versus older groups, respectively, we observed differences in initial graft function, with a greater rate of delayed graft function in the ≥65 group (28.1% vs 17.8%), and in acute rejection rate, which was higher among the younger group (19.4% vs 10.1%). Initial creatinine was better for the older group (1.71 vs 2.10 mg/dL), but similar between the groups at 10 years. Graft and patient survivals at 1, 5, and 10 years were lower among the older group. When analyzing graft survival censored for death with a functioning kidney, there were no differences between the younger and older groups: It was at 1, 5, and 10 years, namely 93.6% versus 90.6%, 87% versus 80.8%, and 76.7% versus 70.1%, respectively.

Selected recipients ≥65 years of age show good outcomes of transplantation.