Elderly kidney transplant recipients: efficacy and risks of a conservative immunosuppression regimen

Introduction: Over the past decade, there has been an increase in renal transplantation among the elderly. However, age-related declines in immune function heighten the risks associated with immunosuppressive therapy, impacting patient survival. This study examines the first year’s immunosuppressive regimen post-kidney transplantation in elderly individuals. Methodology: A singlecenter retrospective cross-sectional study was conducted, categorizing kidney transplant recipients from January 2013 to December 2017 into two groups: a control group (aged 30–50 years) and a seniors group (over 60 years). Results: The study included 59 seniors and 114 controls. Seniorsreceived lower mycophenolate doses (11 ± 7.7 mg/kg/day) compared to controls (15 ± 7.2 mg/kg/day; p = 0.003) and fewer corticosteroids were administered (64.9% vs. 18.6%; p = 0.0001) as maintenance immunosuppression. Seniors also had a higher tacrolimus level-to-dose ratio (p < 0.05). Additionally, seniors experienced more leukopenia (56.5% vs. 35.6%; p = 0.017) and cytomegalovirus infections (44.7% vs. 26.9%; p = 0.034). Conclusion: Despite receiving lower mycophenolate doses and fewer corticosteroids along with a higher tacrolimus level-to-dose ratio, seniors had more adverse events. However, graft survival was not affected. These results suggest that elderly patients may benefit from reduced immunosuppressant exposure, supporting a conservative approach.