[Kidney transplantation in old age]

Older patients clearly benefit from a kidney transplantation despite multiple comorbidities and complications, particularly with respect to life expectancy. Older patients remaining on dialysis on average die earlier compared to patients who underwent a kidney transplantation. In addition, patients experience a significant increase in the quality of life after renal transplantation. However, every patient has to be thoroughly evaluated to assess the individual benefits of a renal transplantation. Geriatric tools are particularly helpful to evaluate the suitability of older individuals. In 1999 the Eurotransplant senior program (ESP or "old for old") was initiated, aiming at shortening waiting time and cold ischemia time for patients on the waiting list. In this program, kidneys of donors aged 65 years and older are locally allocated to recipients also of 65 years and older. The results in ESP are promising, to the effect that this program helps older patients to receive a kidney transplant earlier than by the normal procedure; however, a better alternative to the ESP program is living donor transplantation, provided that a suitable donor is available. There is no age limit for the evaluation of potential donors. Compared to deceased donor kidney transplantation a living donor kidney will most likely function with a higher spontaneous rate and for a longer period of time and therefore provides a clear advantage for older recipients.