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

Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease (ESKD) in all age groups. However, KT in octogenarians is a rare and unique event. We describe the evaluation and clinical course of the world's oldest kidney transplant recipient at 87 years, 262 days, as recognized by the Guinness Book of World Records.

An 84-year-old Canadian retired real estate agent of Indian origin with ESKD due to diabetic nephropathy on hemodialysis presented to our center as a potential kidney transplant candidate. Comorbidities included hypertension, coronary artery disease, benign prostatic hyperplasia, and bilateral knee replacements. He was functional, independent, and extremely keen to undergo KT to further improve his quality of life.

Extensive pretransplant investigation revealed a reasonable state of health for all major organ systems. Multiple specialists were consulted prior to listing.

After 5 years on hemodialysis, he received a standard neurological determination of death donor kidney transplant.

Graft function was immediate. Complications experienced in the first posttransplant year included two urinary tract infections-one with bacteremia; uncontrolled blood pressure and blood glucose, cytomegalovirus and BK viremia, and an inferior wall non-ST segment elevation myocardial infarction. In the second year, he developed a scrotal abscess. However, graft function remained stable with a serum creatinine concentration of 82 µmol/L at two years posttransplant.

Successful KT in advanced octogenarians is possible. Appropriate patient selection is crucial. Extended screening for infection, cardiac and vascular disease, malignancy, and frailty including cognitive deficits is required. Plans for diabetes care and ensuring adequate social support including home care may mitigate complications. Willingness to investigate identified illnesses and seek assistance from other specialists may reduce but not necessarily prevent posttransplant complications. Neurological determination of death donor organs might be preferable for advanced octogenarian KT recipients even if those organs meet expanded criteria.