Experience With Deceased Donor Kidney Transplantation in 114 Septuagenarians.

Abstract

Outcomes of deceased donor (DD) kidney transplantation (KT) in patients ≥70 years of age are understudied. Methods: We retrospectively reviewed DD KT outcomes in patients (pts) ≥70 years transplanted at our center. All pts received antibody induction with FK, half-dose MMF, ± steroids. Results: Over a 10.5 year period, we performed 114 KTs in pts ≥70 (mean 74 years, range 70-84) including 43 pts ≥75. The recipient group included 60 males and 77 Caucasians with a mean waiting time of 20 months. 75 pts (66%) received kidneys from expanded criteria donors (ECDs) including 14 dual KTs. Delayed graft function occurred in 26%. With a mean follow-up of 3 years, pt survival was 83% and kidney graft survival was 77%. One year and death-censored kidney graft survival rates were 91% and 89%. Results were similar in pts < or ≥75 years of age. Of 26 graft losses (GL), 10 occurred within 1 year (6 poor graft function, 4 death with a functioning graft [DWFG]). Of the 16 remaining late GLs, 11 were DWFGs, 3 chronic allograft/polyomavirus nephropathy, and 2 other. DWFG accounted for 15 of the 26 (58%) GLs. In the 11 surviving pts with GL, 2 were retransplanted, 5 are on the waiting list, and 4 died after resuming dialysis. At present, 90 of the 95 surviving pts (95%) have functioning grafts. Causes of death in 19 pts were cardiovascular (13), sepsis (3), and malignancy (3). The incidences of acute rejection and major infection were 14% and 45%. In 33 cases, the mate kidney from the same donor was transplanted into a <70 year old pt (mean age 55.3 years) at our center. With a mean follow-up of 5 years, pt (79% and 94%, p=0.15) and kidney graft survival (64% and 67%) rates in the donor-matched pairs were comparable in the older and younger age cohorts, respectively. Death-censored kidney graft survival (81% older versus 69% younger) rates demonstrated that the older group had more DWFGs (21% versus 3%, p=0.05). Conclusions: Advanced recipient age has a minimal effect on short-term outcomes as acceptable results can be achieved in appropriately selected elderly pts using predominantly ECD kidneys, which may not be appropriate for younger pts. However, medium-term outcomes are largely influenced by a higher incidence of DWFGs in the elderly, suggesting that matching strategies for kidney and patient longevity are warranted.