Results of Kidney Transplantation in Very Old Age Recipients Using Kidneys from Very Old Donors

Abstract

Background Kidney transplantation is the best option for elderly patients with end stage renal disease. The major limitation in this group of patients is shortage of donors since kidneys from young donors are assigned to younger recipients. Spain had 43,4 donors pmp in 2016, 30% of them were aged over 70 years. Kidneys from these donors can be assigned to older patients without detriment to young recipients. Aim Identify clinical factors associated with worse outcomes in very old recipients of grafts from very old donors. Methods Retrospective analysis of pretransplant clinical factors associated with graft and recipient survival in elderly patients (≥70 years) that received a kidney transplant from a very old donor (≥70 years) at our institution from October 2004 to December 2013 (n = 155). Results Median age of donors and recipients was 77 (74-79) and 75 (73-78) years, respectively. The 3-year and 5-year patient survival was 73.1% and 67.1%, respectively. Mortality in the first year was 15.9%. Primary nonfunction was 13.6%. Early graft thrombosis was 7.7%. Death censored graft survival was 83.4% at year 3 and 80.8% at year 5. History of cerebrovascular disease in the recipient was the only factor associated with patient survival (HR 5.12, p=0.027), while history of diabetes melliuts in the recipient was the only factor associated with the risk of graft loss (HR 4.40, p=0.0001). Conclusion Kidney transplantation in patients over 70 years offers a survival advantage over staying on dialysis. History of cerebrovascular disease in the recipient was associated with an increased risk of recipient mortality, while history of diabetes in the recipient was associated with increased risk of graft loss. Further studies are needed to identify pretrasplant clinical factors associated with increased risk of graft failure and recipient mortality in this population in order to improve allocation of these old allografts in the elderly patients. Fundación Mutua Madrileña.