Renal transplantation in patients above 60 years of age in the modern era: A single center experience with a review of the literature

A retrospective study was conducted of 797 patients receiving renal transplants from January 1985 to March 1997. Patient and graft survival was compared for patients above and below the age of 60. Sixty-ninepatients ≤60 years old received 73 kidneys. Race: 73% Caucasian, 26% Black, 1% Other. Sex: 68%M. Hypertension (19) and PCKD (15) were the most common diagnoses. Mean peak panel reactive antibody (PRA) was 37.7%. Donor age was 2 to 66 years. Mean Cold ischemic time was 28.1 hours. Follow-up was untildeath or until 8/30/97. Patients <60 years included:62% Caucasian, 34% Black, 4% Other, 60% male, Mean PRA 39.3. Of the 69 study patients, 27 died: 19 with afunctioning graft, 8 within one year oftransplantation. Cardiovascular causes (19 patients,72%) and infection (7 patients, 24%) were mostcommon. Common causes of graft loss were death witha functioning graft (19) and chronic rejection (15);other causes were acute rejection and primarynon-function. Univariate analysis of 18 risk factorsshowed CHF and past history of vascular surgerysignificantly (p < 0.05) affected time of return todialysis. Multi variate analysis did not show theseindependent variables to be significant. Abnormalejection fraction and presence of q waves on EKGsignificantly affected time to death (p < 0.05) on uniand multi-variate analysis. After censoring patientsthat died with functioning grafts, difference in graftsurvival between ≥60 and <59 years was notsignificant (p > 0.2). In this study, 68% of older patients had allograftsfunctioning at 1 year. The fact that older patientssuccumb over time from natural causes should not keeppatients from transplantation. Immunosuppressiveagents need to be limited to reduce the incidence ofinfection. Criteria need to be refined to define thosewho are at prohibitive risk, who may not be candidatesfor transplantation. This revised version was published online in August 2006 with corrections to the Cover Date.