Should elderly donors be accepted in a live related renal transplant program?

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Abstract
It is a matter of concern that the elderly donor may have increased risks in the peri‐operative period due to age‐related changes in various organs. Nephrosclerosis, atherosclerosis and low GFR of an elderly kidney may portend a poor graft outcome. A retrospective analysis of our live related renal transplant program (from June 1989 to December 1993) revealed that 27 of the donors were above 60 years of age. 21 of the recipients have been followed up for more than 1 year. These patients. were compared with a cohort of 25 patients (donor age <45 years) with similar HLA match, immunosuppressive protocol, and follow‐up period more than 1 year. Graft survival at 1 year was 86% and 88% in the recipients from elderly and younger donors respectively; 1 patient in the control group died of fulminant sepsis. Mean follow‐up was 21.6 months in the study group and 22.8 months in the control group. Allograft function was evaluated by serum creatinine and differential GFR by Te DTPA scan. Serum creatinine (mg %) was 1.3±0.2 and 1.4±0.2 in the study group and 1.3±0.3, 1.2±0.3 in the control group at 3 and 12 months respectively. Glomerular filtration rate (ml/min) was 36.5±11.6 and 43.7±12.4 in the recipients from elderly donors whereas those from the younger donors had GFR (ml/min) of 40.6±9.6 and 49.6±14.2 at 3 and 12 months respectively. GFR continued to improve in both groups with follow‐up. There was no difference in incidence or severity of ATN in the two groups. Acute rejection (17:12) and infectious episodes (18:22) were comparable. The number of antihypertensive drugs requirement per patient was 2.27:1:7 in the two groups. There was no added morbidity in elderly donors in comparison to younger donors. In view of acute donor shortage it can be concluded that, if elderly donors are properly screened, they can be accepted for donation without increasing the risk to donor or graft outcome.