Utilization of the older donor for renal transplantation

BACKGROUND: The persistent shortage of ideal donor organs has resulted in increased transplantation of kidneys from older donors (age > 60 years). The overall experience with this donor subgroup indicates decreased graft survival. METHODS: The records of 413 renal transplants performed between July 1991 and July 1995 were reviewed in a retrospective fashion to determine those patients who had received a cadaveric (CT > 60; n = 17) or living donor (LT > 60; n = 7) renal transplant from an older donor. Control groups consisted of randomly selected patients who received cadaveric (CT < 50; n = 20) or living related (LT < 50; n = 20) renal transplants from donors less than 50 years of age. RESULTS: In the CT > 60 group, 1-year graft survival was 57.4%, significantly less than in those of the LT < 50 (100%), LT > 60 (100%), and CT < 50 (89%) groups. Mean recipient serum creatinine in the CT > 60 group was twofold greater than that of other groups at 1, 6, and 12 months following transplantation, Cold ischemia time and creatinine clearance correlated highly with graft survival. Stepwise regression analysis showed creatinine clearance to be the sole independent predictor of graft survival. A calculated donor creatinine clearance < 50 mL/minute was associated with ultimate graft loss. CONCLUSION: Age alone should not be an exclusion criterion to renal organ donation. When considering the older renal donor, creatinine clearance should be included within the decision algorithm. (C) 1996 by Excerpta Medica, Inc.