Hippokratia 2005; 9(3):115-118
G Vergoulas, Gr Miserlis, Th Eleftheriadis, I Ioannidis, S Patsalas, V Papanikolaou, G Imvrios, I Fouzas, P Papagiannis, D Takoudas
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece
Background. There are controversial reports concerning the impact of age - related immune responses in renal transplant recipients. It has been suggested that, older age relates with lower acute and chronic rejection rate, reduced patient and graft survival and less aggressive immunosuppressive therapy is required. More recent reports refer increased recipient age as an independent risk factor for the development of chronic rejection and a higher incidence of acute rejection episodes. The purpose of this study was to present the experience of our centre with this particular group of patients, clarify their behavior after transplantation, and discuss possible treatment modalities.
Material. The period 1st Jan 1987 - 31st Dec 2003, among 801 kidney transplants, there were 23 recipients with age > 60 years at time of transplantation (mean age 63.47??3.00 years, range 60.5 - 70.5 years), 16 male and 7 female who received 19 cadaveric (CD) and 4 living related donor (LRD) grafts. Immunosuppression was steroids, MMF / azathioprine, CsA and ATG / basiliximab and mean donor age was 51.61?? 17.01 years (range 22.3 - 72.8 years). Initial hospital stay, blood pressure, lipid levels, delayed graft function (DGF), acute rejections (AR), patient and graft loss were recorded and cumulative patient and graft survival was calculated.
Results. During the follow up period there were 9 graft losses due to 8 deaths and 1 infection. Deaths were mainly due to cardiovascular and cerebrovascular accidents (75%) and to a lesser degree to infection (12.5%). The mean stay at 1st hospital admission was 32.60??29.16 days. There were 3 AR episodes (13.63%) and 11 cases with DGF (47.82%). The incidence of AR in pts with DGF and age > 60 years was 9.1 %. The cumulative patient and graft survival one and five years after kidney transplantation were 82.61 % and 74.61 % respectively. Abnormal high blood pressure and lipid levels were recorded in these patients.
Conclusions. The main cause of graft loss in patients with age > 60 years was death. There was no graft loss due to AR or chronic allograft nephropathy. The very high rate of DGF is probably due to high incidence of CD transplants, which caused a very prolonged 1st hospital stay. The low incidence of AR with or without DGF suggests deranged immune response.
Keywords: kidney transplantation, elderly, patient survival, graft survival, delayed graft function, acute rejection, blood pressure, lipid disorders