“Old-for-Old” Cadaveric Renal Transplantation: Surgical Findings, Perioperative Complications and Outcome

Giessing, Markus; Budde, Klemens; Fritsche, Lutz; Slowinski, Torsten; Tüerk, Ingolf; Schoenberger, Bernd; Neumayer, H.-H.; Loening, Stefan A.

doi:10.1016/s0302-2838(03)00380-4

Cited by 60 publications

(45 citation statements)

References 24 publications

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“…Based on our results, we recommend an old-for-old program, 13 where ABO-compatible organs from elderly donors with a negative cross-match, are locally allocated to old recipients.…”

Section: Discussionmentioning

confidence: 88%

“…11 There are, however, some reports where aged recipients had a rejection rate higher than younger controls, ranging from 40% to 70%. 13,14 This can be partially explained, in these studies, by worse compatibility in terms of HLA mismatches presented by the elderly subset of patients. The relationship connecting HLA matching and rate of acute rejections is well known 14 and can be one of the reasons for the few episodes experienced by our elderly recipients, who had a better compatibility compared to the younger ones.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Do Elderly Patients Deserve a Kidney Graft?

Nunes

Mota

Parada

et al. 2005

Transplantation Proceedings

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Purpose. Compare renal transplant long-term outcomes among recipients aged 60 years or older with those in younger patients. Patients and methods. We analyzed 103 transplants in recipients above 60 years of age for the influence of key factors related to the graft and patient. The results were compared with 1060 transplant recipients aged 18 to 59 years. Results. The mean ages were 62.93 and 40.35 years for the older and younger group. The older group showed a higher prevalence of obesity and unknown etiologies for the end-stage renal disease. Important comorbidity was significantly more frequent among recipients aged more than 60 years, mainly of a cardiovascular nature (56% vs 18.5%). Donor age (39.75 vs 31.59 years), cold ischemia time (22.43 vs 20.49 hours) and human leukocyte antigen compatibilities (2.59 vs 2.36) were significantly greater in the older subset. After a mean follow-up of 4.72 and 6.07 years for the older versus younger group, we found no differences in initial graft function, acute rejection rate, and serum creatinine/clearance. Patient and graft survivals at 1, 5, and 10 years were lower among the 60ϩ group. There were no differences in graft survival censored for death with a functioning graft, namely, 95.1%, 89.4%, and 81.2% for the 60ϩ cohort. The main cause of graft loss in the older group was death with a functioning graft. Conclusion. Renal transplantation should be considered for selected patients older than 60 years. Despite a shorter life expectancy, they benefit from it similar to younger recipients. T HE INCIDENCE OF end-stage renal disease (ESRD)increases with advancing age. Patients older than 60 years represent between 53% and 66% of the population requiring renal replacement therapies.1 Therapy for ESRD in the elderly is characterized by tremendous challenges, raising medical, ethical, and socioeconomic concerns. Hemodialysis, the most frequently used renal replacement modality in these patients, is associated with significant morbidity, mortality, and a poor quality of life.2,3 The great organ shortage, higher comorbidity rate, and shorter life expectancy make the allocation of kidneys to this population controversial.Nevertheless, transplantation is the gold standard treatment for ESRD patients. With immunosuppression based upon calcineurin inhibitors, it has become a feasible alternative for the elderly population. 4 -7 Compared with hemodialysis, renal transplantation is associated with a 61% decrease in the long-term risk of death and an additional 4-year life expectancy for patients over 60 years. 4 In this retrospective study, we report a single-center, long-term follow-up of kidney transplants in patients above

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“…Based on our results, we recommend an old-for-old program, 13 where ABO-compatible organs from elderly donors with a negative cross-match, are locally allocated to old recipients.…”

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 92%

Do Elderly Patients Deserve a Kidney Graft?

Nunes

Mota

Parada

et al. 2005

Transplantation Proceedings

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“…Furthermore, surgery may also be a second trigger for thrombosis (see below) in patients with aPL. 30 In old-for-old transplantation, 31 prevalence of thrombotic events is higher than in standard deceased donor renal transplantation. 32 Among patients who lost grafts, three were older than 60 years and had received kidneys from older than 60 years deceased donors.…”

Section: Discussionmentioning

confidence: 99%

Association of Early Kidney Allograft Failure with Preformed IgA Antibodies to β 2-Glycoprotein I

Morales

Martínez-Flores²,

Serrano

et al. 2015

Journal of the American Society of Nephrology

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“…Thus, less intense induction and immunosuppression appear sufficient. However, if significant HLA-mismatch is present, higher rates of acute rejection have been described (Frei et al, 2008;Fritsche et al, 2003;Giessing et al, 2003). Nevertheless, the safety profile of www.intechopen.com IL-2 receptor antibodies in patients with considerable comorbidities, such as the older recipients, may be preferred.…”

Section: Older Recipientsmentioning

confidence: 99%