Kidney transplantation in the elderly - the Norwegian experience

Background. Elderly patients are the fastest growing population requiring renal replacement therapy. With increasing scarcity of organs, old patients are likely to remain in dialysis. We have had an active transplant program with elderly patients (i.e. >= 70 years) and present results from our experiences. Methods. From 1990 throughout 2005, we performed 301 first kidney transplantations in elderly patients. Data were compared with 513 senior patients aged 60-69 years and 512 control patients, aged 45-54 years, transplanted during the same time period. Time in dialysis prior to transplantation, number of patients receiving a living donor (LD) kidney, donor age, HLA mismatch, rejections, patient- and graft survival data were collected. Results. The 5-year actuarial patient survival was 56% in elderly patients, 72% in senior patients; P < 0.001 versus elderly and 91% in control patients; P < 0.001 versus elderly. Death censored graft survival was similar in the different groups, 89% in elderly, 88% in senior and 90% in control patients. LD was used in 35%; 17% in elderly patients, 34% in senior patients; P < 0.001 and 47% in control patients; P < 0.001. Pre-emptive transplantation was performed in 19% of the patients; 10% in elderly patients, 18% in senior patients; P = 0.003 and 25% in control patients; P < 0.001. Conclusions. Our data show no difference in death censored graft survival between the age groups. Given the poor prognosis during dialysis treatment, selected elderly patients may successfully be offered a kidney transplant.