Renal transplantation with limit donors: to what should the good results obtained be attributed?

With the aim of offsetting the reduction in donors of kidneys for transplantation, we extended the acceptance criteria, considering donors over 60 years old.

The results obtained in 84 transplants carried out with this type of donor (group A) was compared with those of a control group of 125 transplants carried out with kidneys from donors under 60 years old (group B). The protocol for selection of donors was appropriate creatinine clearance, minimum proteinuria, and normal renal scan. The histological study was not included because it was not considered appropriate to assess the extent of the possible glomerulosclerosis, as this has a focal, segmented distribution. There were no significant differences between the recipients except for age (57.8 years old in group A vs. 39.2 years in group B).

After the transplantation, there were significant differences in the duration of hospitalization (26.8 days vs. 21.8 days, P<0.009), annual plasma creatinemia (177, 225, 233, 235, and 205 micromol/L vs. 136, 150, 121, 111, and 133 micromol/L, P<0.0002/0.0004), graft survival (87%, 85%, 81%, 81%, and 81% vs. 89%, 88%, 86%, 86%, and 85%, P<0.03), and patient survival (92%, 89%, 85%, 85%, and 85% vs. 99%, 99%, 97%, 96%, and 95%, P<0.0004). Death of the patient was the only significantly more frequent cause of graft loss among group A patients (7 vs. 1 death, P<0.004). No kidney was "never working" and none were lost because of chronic rejection.

It was concluded that elderly donors should be considered as suitable for transplantation irrespective of their chronological age, provided that they fulfill the acceptance criteria. The quality of life achieved was comparable in both groups. Despite the lower renal function in group A, this remained constant during the follow-up period.