Renal transplantation in the elderly: South Indian experience

Abstract

In developing countries, renal transplantation is offered to young end-stage renal disease (ESRD) patients, while the older ones face limitations due to higher mortality risk. We retrospectively analyzed 225 patients who underwent renal transplantation from living donors, aged 40-60years (Group A) and >60years (Group B), focusing on their survival outcome. Group A (n=181) had mean creatinine (mg/dL) 1.41±0.84, 1.30±0.65 and 1.40±0.60 and mean eGFR (mL/min/1.73 m(2)) of 65.32±23.03, 69.14±32.65 and 59.21±22.79 at 0, 3 and 6months post-transplantation. Death-censored graft survival was 93.1% in first year followed by 91.2% in subsequent 4years. Patient survival was 92.5% in first year, 90.7% in the next 2years, and 89.2% in 4th year. Highest cumulative graft survival was 86.7% in the first year with 83.4%, 82.7% and 82.4% during the subsequent 3years. Group B (n=44) had mean creatinine (mg/dL) of 1.46±1.02, 1.29±0.23 and 1.2±0.29 with a mean eGFR (mL/min/1.73 m(2)) of 67.90±23.48, 67.02±12.76 and 75.23±15.19 at 0, 3 and 6months. Highest death-censored graft survival was 97.4% in the first year with 94.7% in next 3years. Patient survival was 88.1% throughout 4years post-transplantation. Cumulative graft survival was 84.1% during 4years. Biopsy-proven acute rejection rate was 28.7% in group A and 15.9% in group B (P=0.058). There was higher mortality rate in group B with death mainly due to infections and cardiovascular complication. Cardiovascular risk assessment, pre-transplant cancer screening and judicious use of immunosuppressive agents should help minimize adverse events, balanced with an inherently reduced risk of acute rejection, hence the graft survival advantage and is the way forward to maximize patient and renal allograft survival in elderly patients.