NDT Advance Access originally published online on January 18, 2008
Nephrology Dialysis Transplantation 2008 23(6):2043-2051; doi:10.1093/ndt/gfm912
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Renal transplantation in the elderly: surgical complications and outcome with special emphasis on the Eurotransplant Senior Programme
1 Department of Urology and Paediatric Urology 2 Department of Urology and Paediatric Urology, Division of Biostatistics 3 Department of Nephrology, Medical Clinic III, Johann Wolfgang Goethe-University 4 KfH Kidney Centre, Frankfurt am Main, Germany
Correspondence and offprint requests to: Wassilios Bentas, Department of Urology and Paediatric Urology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Tel: +49-69-6301-5065; Fax: +49-69-6301-6464; E-mail: Bentas{at}em.uni-frankfurt.de
 |
Abstract |
|---|
Background. The purpose of this retrospective study was to evaluate the results of the Eurotransplant Senior Programme (ESP) within our centre compared to elderly recipients 
60 years from the regular Eurotransplant Kidney Allocation System (ETKAS), specifically focusing on surgical aspects.
Methods. Data from 73 ESP patients (average donor/recipient age: 71.1/67.1) were compared with those from 51 patients (49.7/63.6) treated within the framework of the ETKAS program between the years 1999 and 2006. The mean follow-up was 39.5 months.
Results. Cold ischaemic time (ESP versus ETKAS: 10.3 versus 15.0 h), duration of renal replacement therapy (42.2 versus 76.8 months), donor glomerular filtration rate (81.7 versus 109.9 ml/min/1.73 m2) and HLA mismatches (4.1 versus 2.4) were significantly different between the two groups (all P < 0.001). Primary graft function was seen in 74% ESP versus 69% of ETKAS patients (P > 0.05). The rate of surgical complications in the ESP versus ETKAS group was 47% versus 28% (P = 0.031) and the revision rate, 33% versus 24% (P = 0.259). Three-year patient and censored graft survival was 84% versus 92% and 85% versus 88% in the ESP and ETKAS group, respectively (all P > 0.05). Ninety-five percent of all deceased patients died with a functioning graft.
Conclusions. The donor and recipient pool has been markedly expanded through ESP with similar patient and graft survival compared to elderly recipients grafted according to ETKAS criteria. However, patients and their physicians should be aware of the high surgical complication rate in elderly recipients, particularly when receiving elderly donor kidneys. This might seriously influence postoperative patient management but ultimately does not compromise the transplant outcome.
Keywords: elderly renal transplant recipient; Eurotransplant Kidney Allocation System (ETKAS); Eurotransplant Senior Programme (ESP); renal transplantation; surgical complications
Received for publication: 26. 7.07
Accepted in revised form: 3.12.07