Kidney Transplantation in Advanced Octogenarians: The World's Oldest Kidney Transplant Recipient

Area of Science:

• Nephrology
• Transplantation Surgery
• Geriatric Medicine

Background:

• Kidney transplantation (KT) is the optimal treatment for end-stage kidney disease (ESKD).
• KT in octogenarians is uncommon due to complex comorbidities and frailty.
• This case study details the oldest kidney transplant recipient, aged 87 years and 262 days.

Purpose of the Study:

• To describe the evaluation and clinical course of an octogenarian kidney transplant recipient.
• To highlight the feasibility and challenges of KT in advanced elderly patients.
• To identify key considerations for successful transplantation in this demographic.

Main Methods:

• A comprehensive pre-transplant evaluation of an 84-year-old male with ESKD due to diabetic nephropathy.
• Involvement of multiple specialists to assess organ system health.
• Receipt of a standard neurological determination of death donor kidney transplant after 5 years of hemodialysis.

Main Results:

• The patient, the world's oldest KT recipient, experienced immediate graft function.
• Complications included infections, cytomegalovirus/BK viremia, and myocardial infarction.
• Despite complications, graft function remained stable at two years post-transplant (serum creatinine 82 µmol/L).

Conclusions:

• Successful KT is achievable in advanced octogenarians with meticulous patient selection and thorough screening.
• Extended evaluation for infection, cardiovascular disease, malignancy, and frailty is essential.
• Neurological determination of death donor organs may be preferable for this age group.