Clinical implications and surgical management of intussusception in pediatric patients with Burkitt lymphoma

Background/Purpose

Intussusception as a presenting feature of Burkitt lymphoma may be associated with early stage disease, which is curable with less intensive therapy. We determined the incidence, presentation, stage, and outcome of children with Burkitt lymphoma presenting with intussusception.

Methods

The medical records of patients with Burkitt lymphoma treated at our hospital from 1962 to 2005 were reviewed, and the patients presenting with intussusception were then further analyzed.

Results

Of 189 patients with primary abdominal Burkitt lymphoma, 33 (17.5%) presented with intussusception. Their median age at diagnosis was 10 years (range, 3-19 years). Most patients presented with abdominal pain (88%) and/or nausea/vomiting (42%). Twenty-three (70%) of these 33 patients as compared with 10 of the other 156 patients with abdominal lymphoma could have complete resection of their tumor (P < .0001) and hence had low stage disease (stage II). Only 10 patients with intussusception had stage III (n = 7) or stage IV (n = 3) unresectable disease. Twenty-five of the patients remained alive in continuous complete remission for 3 months to 31 years (median, 14 years).

Conclusion

Pediatric patients with Burkitt lymphoma presenting with intussusception often have completely resectable disease and are older than general pediatric patients with intussusception.     

Hyperhomocysteinemia after kidney transplantation

Objective

To determine the prevalence of hyperhomocysteinemia (plasma homocysteine[Hcy] concentration ≥15 μmol/L) and evaluate its correlation with allograft function.

Materials and Methods

The study included 159 stable renal transplant recipients (104men and 55 women). The prevalence and severity of hyperhomocysteinemia werecompared in the transplant recipients vs 72 patients (48 men and 24 women) receivinghemodialysis therapy.

Results

The mean (SD; range) fasting total Hcy concentration was higher in thehemodialysis group compared with the renal transplantation group: 27.4 (18.3; 10-95)μmol/L vs 16.6 (9.5; 4.5-45.0) μmol/L (P = .00). Hyperhomocysteinemia occurred morefrequently in patients receiving hemodialysis therapy (74% vs 49%). No significantcorrelation was observed between Hcy concentration and recipient sex, cyclosporinetrough concentration and concentration at 2 days after dosing, dyslipidemia,cytomegalovirus infection, diabetes mellitus, or aspartate or alanine aminotransferaseconcentration. Multivariate regression analysis revealed that serum creatinineconcentration (P = .02) was the major determinant of increased total Hcy concentration inrenal transplant recipients.

Conclusion

A high prevalence of moderate hyperhomocysteinemia was observed in renaltransplant recipients. There was no correlation between graft function and Hcyconcentration.     

Impact of Continuous Value of Body Mass Index on Graft Loss in Overweight Patients

Introduction

High body mass index (BMI) is associated with increased cardiovascular mortality and risk of progression to end-stage renal disease both among the general population and among renal transplant patients. However, in the latter condition no unequivocal studies have been reported in the literature. The aim of our study was to investigate continuous versus categorical values of BMI (World Health Organization classification) as an independent risk factor in renal transplantation.

Patients and methods

We retrospectively studied 194 renal transplant patients (128 males and 66 females) whose mean age at transplant was 43.9 years. They had 5 years follow-up. To investigate the association between BMI and graft survival, we performed univariate and multivariate analyses using the Cox regression model. This model was adjusted both for classical covariates (age, gender, time on dialysis, HLA mismatches, donor status) and other covariates as delayed graft function (DGF), acute rejection episodes (AR), and chronic allograft nephropathy (CAN), which are universally recognized to be predictors of graft loss as evidenced by a need for dialysis treatments.

Results

At the time of transplantation, the BMI averaged 24.4 ± 2.65 kg/m². Upon univariate analysis, age (P = .049), BMI (P = .005), DGF (P = .009), ARE (P < .0001), and CAN (P = .001) were significantly related to poor transplant outcomes. Upon multivariate analysis, only the BMI value, considered as continuous value (P = .013), DGF (P = .030), and ARE (P < .0001) were significantly related to graft loss.

Conclusions

BMI as a continuous value represented an independent risk factor for renal transplant loss at 5 years. Correction of pretransplant body weight both in overweight (25 ≤ BMI ≤ 30) and normal-weight patients is essential to avoid graft loss.     

Survival of lupus nephritis patients after renal transplantation in malaga

Background

Studies have shown that the survival of patients with lupus nephritis (LN) who receive a transplant has results similar to those of nondiabetic control subjects.

Objective

The aim of this study was to evaluate the survival of lupus patients who received a transplant at our center, and to determine risk factors for mortality and graft loss.

Methods

This case-control (1:2) study comprised patients with chronic kidney disease secondary to LN who received a kidney transplant (n = 32) in the Malaga area from 1985 to 2010. The controls subjects (n = 64) were matched by age, sex, and transplant period. We analyzed graft and patient survivals and risk factors compared with long-term transplant patients without LN.

Results

No differences were found in the variables analyzed between groups, except for the most frequent cause of donor death, which was almost significant: stroke in LN and traumatic brain injury in control subjects (P = .05). of the whole study sample, 45% lost the graft, primarily owing to chronic kidney disease (53.5%), followed by vascular thrombosis (16.3%); P = .57. Censored graft losses occurred in 63% of the patients transplanted before 2000, whereas it occurred in 20% of those transplanted after 2000 (P < .001). Censored graft survival was similar between the groups throughout the followup, as was patient survival. Cox regression showed that only acute rejection was associated with a 2-fold increased risk of graft loss.

Conclusions

Our lupus transplant population showed no differences in graft or patient survival compared with control subjects. Those patients who received a transplant from 2000 had better results, which may be related to several factors, such as immunosuppression, correction of cardiovascular conditions, or other factors. Risk factors for death and graft loss were similar to the control population.     

Gastroesophageal Reflux Disease Is Associated With an Increased Rate of Acute Rejection in Lung Transplant Allografts

Purpose

Gastric fundoplication (GF) for gastroesophageal reflux disease (GERD) may protect against the progression of chronic rejection in lung transplant (LT) recipients. However, the association of GERD with acute rejection episodes (ARE) is uncertain. This study sought to identify if ARE were linked to GERD in LT patients.

Methods

This single-center retrospective observational study, of patients transplanted from January 1, 2000, to January 31, 2009, correlated results of pH probe testing for GERD with ARE (≥International Society for Heart and Lung Transplantation A1 or B1). We compared the rates of ARE among patients with GERD (DeMeester Score > 14.7) versus without GERD as number of ARE per 1,000 patient-days after LT. Patients undergoing GF prior to LT were excluded.

Results

The analysis included 60 LT subjects and 9,249 patient-days: 33 with GERD versus 27 without GERD. We observed 51 ARE among 60 LT recipients. The rate of ARE was highest among patients with GERD: 8.49 versus 2.58, an incidence density ratio (IDR) of 3.29 (P = .00016). Upon multivariate negative binomial regression modeling, only GERD was associated with ARE (IDR 2.15; P = .009). Furthermore, GERD was associated with multiple ARE (36.4% vs 0%; P < .0001) and earlier onset compared with patients without GERD: ARE proportion at 2 months was 0.55 versus 0.26 P = .004).

Conclusion

In LT recipients, GERD was associated with a higher rate, multiple events, and earlier onset of ARE. The efficacy of GF to reduce ARE among patients with GERD needs further evaluation.     

Induction With Basiliximab in Renal Transplantation

Introduction

The use of monoclonal antibodies in renal transplantation for induction therapy has been associated with a marked reduction in acute rejection rates with an impact on graft and patient survivals.

Objective

We sought to evaluate the efficacy of renal transplant induction protocols using Basiliximab based on the rates of acute rejection episodes (ARE) and delayed graft function (DGF) of infectious complications in the first 6 months posttransplant, as well as patient and graft survivals.

Methods

We retrospectively evaluated all renal transplants performed between 2000 and 2008 that were primary grafts from cadaveric heart-beating donors, into recipients with a panel reactive antibody titer <5% and who were treated with an immunosuppression scheme based on cyclosporine, mycophenolate mofetil/mycophenolic acid plus corticosteroids, with (group 1) or without basiliximab (group 2).

Results

We enrolled 52 recipients in group 1 (induction with basiliximab) and 189 in group 2 (without basiliximab). The baseline characteristics were similar among the groups, except for time on dialysis which was longer in group 1 and the number of HLA matches, which was lower in group 1. The ARE rate was lower among group 1 (7.8% vs 27.8%; P = .001); rates of DGF and infectious complications were similar. There was no significant difference in graft and patient survivals.

Conclusion

In this study, induction with basiliximab was associated with a reduced rate rate of ARE, despite a lower number of HLA matches and a longer previous time on dialysis. The use of this induction modality was not associated with a greater rate of infectious complications.     

Disturbances of kidney graft perfusion as indicators of acute renal vein thrombosis in contrast-enhanced ultrasonography

Introduction

The aim of this study was to evaluate the usefulness of contrast-enhanced ultrasound (US-CE) to diagnose acute renal vein thrombosis (ARVT), acute rejection episodes (ARE), or acute tubular necrosis (ATN) in kidney grafts.

Materials and methods

We analyzed 171 US-CE among kidney transplantation patients in the early postoperative period. Patients underwent US-CE following a standard diagnostic protocol including real-time ultrasound (B-mode) and color Doppler ultrasound with spectral flow analysis. Tissue perfusion was analyzed based upon time-intensity curves for two regions: the renal cortex and the renal pyramids.

Results

Of 14 patients, in whom standard ultrasound showed high resistance parameters in the renal artery, three showed ARVT and 11 had ATN or ARE, which were confirmed by biopsy. Among patients with ARVT, the US-CE showed a lack of contrast perfusion into the cortex and renal pyramids. Patients with ARE/ATN showed slower contrast inflow into the parenchyma with reduced but still present perfusion. The differences in mean signal intensity values were significant for both the cortex and the renal pyramids: cortex: −53.8 ± 5.4 dB versus −35.0 ± 3.5 dB (P < .05) and pyramids: −54.8 ± 5.4 dB versus −37.0 ± 3.5 dB (P < .05).

Conclusion

US-CE is a noninvasive method that provides easy, reliable differentiation of ARVT from ARE/ATN.     

Plasmapheresis therapy in renal transplant patients: five-year experience

Introduction

Plasma exchange (PE) and double-filtration plasmapheresis (DFPP) have been used successfully in renal transplant patients as well as those with various other diseases over the last decade. In this retrospective study, we sought to explore the outcomes of plasmapheresis in renal transplant patients.

Patients and methods

We investigated 58 patients who received PE or DFPP therapy between 2005 and 2010. PE was performed using a Fresenius AS.TEC 204 device and DFPP, by an INFOMED HF 440 device. Indications for therapy, biopsy findings, number of PE/DFPP sessions, laboratory data, medications, complications as well as graft and patient survivals were recorded.

Results

Overall mean age of subjects was 34.1 ± 8.8 years and 55% were female. Sixteen patients underwent 95 DFPP sessions and 42 underwent 215 PE sessions. Indications for therapy were acute humoral rejection (n = 39), recurrent focal segmental glomerulosclerosis (FSGS; n = 8), thrombotic microangiopathy (n = 6), and chronic humoral rejection (n = 5). Responses to therapy were 24/39 for acute humoral rejection, 1/5 for chronic rejection, 4/8 for FSGS, and 3/6 for thrombotic microangiography. No complication was observed in any patient.

Conclusion

PE/DFPP is a safe and succesful method for treatment of acute humaral rejection as less so for recurrent FSGS and thrombotic microangiopathy. The outcomes among subjects with chronic humoral rejection were not satisfactory.     

Impact of Recipient and Donor Nonimmunologic Factors on the Outcome of Deceased Donor Kidney Transplantation

Objective

To study the influence of nonimmunologic factors on the outcome of extended criteria deceased donor (DD) kidney transplants.

Method

This is a retrospective study of DD transplantation carried out from January 1, 2003 to December 31, 2007, to investigate the impact on graft survival and function of donor renal function at retrieval, cold ischemia time (CIT), delayed graft function (DGF), acute rejection episodes (ARE), age, and weight of donors and recipients, transplant center activities, cause of donor death, donor-recipient gender pairing and size of the donating intensive care unit (ICU).

Results

At retrieval, the frequency of donors with a creatinine clearance <60 mL/min, using the Cockcroft-Gault formula, and age >40 years were 31.7% and 32%, respectively. CIT > 24 hours, DGF, and ARE occurred in 27.1%, 33.4%, and 16.5% of cases, respectively. The overall 1- and 5-year graft and patient survival rates were 88% and 79.8% and 96.6% and 92.3%, respectively. The graft function was inferior with occurrences of ARE (P = .0001), DGF (P = .0001), CIT > 20 hours (P = .005), nontraumatic the donor death (P = .022), and donor ICUs bed capacity <20 (P = .03). The odds ratio (OR) for graft loss with DGF, ARE, and donors right kidneys were 7.74 (95% confidence interval [CI] 6-13.4; P = .0001), 4.47 (95% CI, 2.6-7.6; P = .0001) and 1.7 (95% CI, 1-2.8; P = .045), respectively. Graft function was not influenced by donor renal function at retrieval, donor weight, or donor- recipient gender pairings.

Conclusion

CIT and ARE had an impact on both graft survival and function. DGF and cerebrovascular accidents as the cause of donor death negatively affected graft function during follow-up. ICU center experience had a positive impact on graft survival. Patient survival was affected by recipient age >50 years and female to male donation versus other gender pairings. Neither donor age nor acute terminal rise in the donor serum creatinine affected graft function or survival, or patient mortality.     

Preemptive Living-Donor Renal Transplantation: Outcome and Clinical Advantages

Introduction

Kidney transplant recipients have a higher quality of life and consume fewer health care resources compared with patients on dialysis. However, optimal timing of transplantation has been controversial. Recent studies have clearly demonstrated that preemptive renal transplantation is associated with better graft survival, lower complications, and better cost-effective outcomes. We evaluated differential effects on long-term outcomes according to dialysis type/duration versus no dialysis.

Materials and Methods

We retrospectively analyzed 499 cases of first living-donor kidney transplantations performed in our center from January 1990 to January 2007. We compared 3 groups according to graft survival, acute and chronic rejection, postoperative complication, and delayed graft function rates. The mean duration of follow-up was 119.1 ± 47.2 months.

Results

Among 499 cases, 81 cases were preemptive renal transplantations with 418 cases hemodialysis [HD], 343 cases, peritoneal dialysis [PD] 75 cases) performed after dialysis. The 1-, 5-, and 10-year graft survival rates were 98.8%, 89.5%, 79.4% among the preemptive renal transplantation group and 92.4%, 78.2%, and 69.2% and 85.3%, 74.5%, and 68.2% (P = .03) in the dialysis groups (HD, PD), respectively. The differential effect of pretransplantation HD or PD was not significant. However, the graft survival rates in the HD group were not significantly higher than the PD group (P = .61). The duration of dialysis was not associated with graft survival.

Conclusion

We suggest that preemptive renal transplantation should be the first choice of treatment for patients with end-stage renal disease.     

The risk factors to predict acute rejection in liver transplantation

Purpose

The aim of this study was to evaluate risk factors for an acute cellular rejection episode (ARE) among adult liver transplant (OLT) patients.

Materials and methods

We retrospectively reviewed 110 consecutive patients who underwent OLT between May 2007 and December 2010. The diagnosis of ARE was based upon clinical and biochemical data; liver biopsy was only performed when clinical presentation was equivocal. We recorded donor and recipient characteristics, perioperative immune status, and postoperative laboratory data. Forty patients (36.4%) who suffered a clinical rejection episode and received pulsed or recycled steroid therapy (R group), were compared with 70 (63.6%) free of rejection (N group).

Results

The mean age of R recipients was 46.61 ± 9.97 years, which was younger than the N group (51.86 ± 8.37, P = .005). R group patients displayed a lower pre-OLT creatinine (P = .016) and higher alanine aminotransferase (P = .048). Cox regression model showed recipient age to be the only significant factor to predict ARE (odds ratio = 1.071, P = .003). The cutpoint of age was 46 years by receiver operating characteristic analysis. Patients younger than 46 years showed higher initial CD8⁺ T-cell counts (P = .038).

Conclusion

Recipient age was significantly associated with ARE; younger patients showed higher CD8⁺ lymphocyte counts than older patients. More aggressive immunosuppression should be considered for younger recipients to prevent ARE.     

Prognostic Effect of Lymphocyte Subgroup CD4+ and CD8+ Cells in Peripheral Blood in Renal Transplant Patients With Cytomegalovirus Viremia

Objective

Our aim was to evaluate the prognostic effect of peripheral blood lymphocyte subgroup CD4+ and CD8+ cells on renal transplant patients with cytomegalovirus (CMV) viremia.

Materials and Methods

Using 41 renal transplant patients with CMV-PCR(+) in peripheral blood and stable values of serum creatinine (SCr), we evaluated the changes in lymphocyte subgroup CD4+ and CD8+ cells with onset of antiviral therapy with gancyclovir for treatment of pneumonia. We compared patients with or without pneumonia.

Results

The lower the peripheral blood lymphocyte subgroup CD4+ and CD8+ cell numbers, the higher the incidence of CMV pneumonia. The numbers of CD4+ and CD8+ cells at 1 month posttransplantation and at the time of CMV-PCR(+) detection were significantly lower than those before transplantation in the CMV pneumonia group (P < .01) and also in the nonpneumonia group.

Conclusions

The decrease in peripheral blood lymphocyte subgroup CD4+ and CD8+ cells after renal transplantation in patients with CMV viremia showed prognostic value for pneumonia. Increased CD4+ and CD8+ cells in peripheral blood combined with preemptive therapy may reduce the incidence of pneumonia among patients with CMV viremia.     

Do intraoperative hemodynamic factors of the recipient influence renal graft function?

Purpose

To assess the importance of intraoperative management of recipient hemodynamics for immediate versus delayed graft function.

Methods

The retrospective study of 1966 consecutive renal transplants performed in our department between June 1980 and December 2009 analyzed several perioperative hemodynamic factors: central venous pressure (CVP), mean arterial pressure (MAP) as well as volumes of fluids, fresh frozen plasma (FFP), albumin, and whole blood transfusions. We examined their influence on renal graft function parameters: immediate diuresis, serum creatinine levels, acute rejection, chronic transplant dysfunction, and graft survival.

Results

Mean CVP was 9.23 ± 2.65 mm Hg and its variations showed no impact on graft function. We verified a twofold greater risk of chronic allograft dysfunction among patients with CVP ≥ 11 mm Hg (P < .001). Mean MAP was 93.74 ± 13.6 mm Hg; graft survivals among subjects with MAP ≥ 93 mm Hg were greater than those of patients with MAP < 93 mm Hg (P = .04). On average, 2303.6 ± 957.4 mL of saline solutions were infused during surgery. Patients who received whole blood transfusions (48%) showed a greater incidence of acute rejection episodes (ARE) (P = .049) and chronic graft dysfunction (P < .001). Patients who received FFP (55.7%), showed a higher incidence of ARE (P < .001). Only 4.6% of patients (n = 91) received human albumin with a lower incidence of ARE (P = .045) and chronic graft dysfunction (P = .024). Logistic binary regression analysis revealed that plasma administration was an independent risk factor for ARE (P < .001) and chronic dysfunction (P = .028). Volume administration (≥2500 mL) was also an independent risk factor for chronic allograft dysfunction (P = .016). Using Cox regression, we verified volume administration ≥ 2500 mL to be the only independent risk factor for graft failure (P < .001).

Conclusion

MAP ≥ 93 mm Hg and perioperative fluid administration <2500 mL were associated with greater graft survival. Albumin infusion seemed to be a protective factor, while CVP ≥ 11 mm Hg, whole blood, and FFP transfusions were associated with higher rates of ARE and chronic graft dysfunction.     

Successful Steroid Withdrawal After Long-Term Adminstration in Renal Transplant Patients

Objective

This study evaluated the effect of steroid withdrawal after long-term administration on stably functioning renal transplant recipients.

Methods

Between April 2000 and October 2006, steroid administration was safely withdrawn in 47 patients with stable graft function for >1 year after renal transplantation. The period between renal transplantation and steroid withdrawal varied from 12 to 234 months. We also investigated the current steroid doses of all 274 outpatients who had undergone renal transplantation at our hospital between July 1977 and October 2006.

Results

Twelve patients out of 47 had to resume steroid administration, 10 (21%) owing to acute rejection with/without recurrent glomerulonephritis, 1 owing to treatment of subacute thyroiditis, and the other owing to accompanying cessation of azathioprine for ovarian cancer. Thirty-five patients have maintained stable graft function for 12 to 90 months (median, 49) after steroid withdrawal as confirmed by follow-up. At present, only 1 of the 47 patients had to resume hemodialysis owing to chronic deterioration of renal graft function. The current steroid doses (prednisolone equivalent) of the 274 outpatients at our hospital are as follows: The number of patients for withdrawn, <5 mg, 5 mg, >5 to 10 mg, and >10 mg/d is 38, 20, 155, 57, and 4, respectively. Of 294 patients, 213 (77.7%) are maintaining stable renal graft functions on ≤5 mg prednisolone per day.

Conclusion

Steroids can be safely withdrawn in renal transplant patients with stable graft functions, even after long-term administration.     

Effects of ischemia and reperfusion injury on long-term graft function

Background

The clinical manifestation of ischemia/reperfusion injury in renal transplantation is delayed graft function (DGF), which is associated with an increase in acute rejection episodes (ARE), costs, and difficulties in immunosuppressive management. We sought to evaluated the DGF impact after renal transplant.

Methods

We evaluated a group of 628 patients undergoing deceased donor renal transplantation between 2002 and 2005 at 3 Brazilians institutions to define the main DGF characteristics.

Results

DGF incidence was 56.8%, being associated with elderly donors (P = .02), longer time on dialysis (P = .001), and greater cold ischemia time (CIT; P = .001). Upon multivariate analysis, time on dialysis >5 years increased DGF risk by 42% (P = .02) and CIT >24 hours increased it by 57% (P = .008). In contrast, DGF was associated with an higher incidence of ARE: 27.7% in DGF versus 18.4% in IGF patients (P = .047). The ARE risk was 46% higher among individuals with DGF (P = .02), 44% among patients >45 years old (P < .001), 50% among those with >5 years of dialysis time (P = .02), and 47% lower among the who were prescribed mycophenolate instead of azathioprine (P < .001). Patients with DGF showed worse 1-year graft function (54.6 ± 20.3 vs 59.6 ± 19.4 mL/min; P = .004), particularly those with ARE (55.5 ± 19.3 vs 60.7 ± 20.4; P = .009). One-year graft survival was 88.5% among DGF versus 94.0% among non-DGF patients.

Conclusion

The high incidence of DGF was mainly associated with a prolonged CIT. There was a relationship between DGF and ARE, as well as with a negative influence on long-term graft function.     

Relationship Between Platelet Activation and Acute Rejection After Renal Transplantation

Objective

To provide an earlier diagnosis and efficiently treat acute rejection episodes (ARE) after renal transplantation, we studied its relationship to platelet activation.

Patients and Methods

The peripheral blood levels of platelet surface glycoprotein (CD61), platelet activation-dependent granule membrane protein (CD62p), lysosomal enzyme glycoprotein (CD63), macula densa granule membrane glycoprotein (CD42a), and fibrinogen receptor monoclonal antibody (PAC-1) among 203 patients with uremia in various stages before and after transplantation were assayed by flow cytometry. The patients with ARE were prospectively and randomly assigned to either a treatment group with an antiplatelet activation agent or a control group.

Results

The incidence of ARE was remarkably increased among patients with greater expression levels of platelet activation markers in peripheral blood preoperatively. The values of platelet activation markers were significantly higher among patients with ARE compared with those showing either normal graft function or acute tubular necrosis. The greater the increase in CD63, the worse the ARE. The expression levels of platelet activation markers decreased remarkably among the group treated with a platelet activation inhibitor in addition to antirejection therapy: the rejection reversal time shortened and the dose of antihuman thymocyte globulin (ATG) was lower. The sensitivity of platelet activation markers was better than its specificity.

Conclusions

Our studies demonstrated an association between platelet activation and ARE after renal transplantation. Platelet activation before transplantation can predict the occurrence of ARE. Platelet activation inhibitor therapy after transplantation improved ARE reversal.     

Clinical characteristics and outcomes of renal transplantation in elderly recipients

Background

Elderly renal transplant candidates constitute one the fastest-growing populations among end-stage renal disease patients. Since the impacts of advanced recipient age have not yet been fully defined, we evaluated the clinical characteristics and outcomes of elderly renal transplant recipients.

Methods

Among 564 adult renal transplant recipients, at our center between 2000 and 2009, 64 were at least 60 years of age (Elderly group), and 500 were younger than 60 years (Young group) at the time of the procedure. We compared their clinical features and surgical management.

Results

There were significant differences in mean donor age (55.6 years vs. 53.2 years, P = .030) and gender mismatch (77.0% vs. 63.4%, P = .035). However, there were no significant differences between the two groups in patient and graft survivals (P = .177 and P = .365, respectively). Malignancy after transplantation was a significant risk factor upon univariate evaluation but only ABO incompatibility upon multivariate analysis of patient and graft survival. The main cause of graft loss among the Elderly group was death with a functioning graft due to heart failure.

Conclusions

Renal transplantation is a feasible, safe option for the elderly and should be actively implemented. However, screening for cancer and heart disease should be mandatory to improve outcomes.