Renal Transplant for Recipients Over 60 Years Old

Approximately 50% of the patients who begin dialysis are currently >60 years old(1). They are progressively accepted by different work teams as renal transplant candidates, although with differing results (1, 2, 3, 4, 5, 6, 7). The abundant additional pathologic features in older adult uraemic patients could either contraindicate treatment or negatively influence its outcome. The patient selection method is, therefore, important. The greatest controversy occurs with cardiovascular pathologic features. Restrictive criteria prevent transplantation in most patients, whereas relaxed criteria may increase posttransplant mortality. We chose a recipient study to form part of the waiting list, including a noninvasive study of the cardiocirculatory apparatus. In the presence of heart failure, an echocardiogram is performed, rejecting those patients with an ejection fraction <30%. If cardiac angor is detected, a coronariography is performed. A coronary by-pass is performed on the patients having a lesion in the left main trunk or lesions in 2–3 coronary vasa with an ejection fraction <40%. Transluminal dilatation is used only in patients with a coronary lesion. Those patients with angor not responding to medical and/or surgical treatment are rejected for transplantation. If there are signs of peripheral vascular insufficiency, an aorto-iliac arteriography is performed, rejecting those patients with severe arterial lesions not subject to surgical correction. Using this prior study, we have performed 53 consecutive renal transplantations on patients >60 years old using cadaver donors (group 1) and we have compared renal function and survival of the patient and of the graft with results obtained in a control group of 154 younger patients (group 2). In both groups, the donors were selected according to a protocol already described (8) and the induction of immunodepression was quadruple sequential (polyclonal antibodies, prednisone, azathioprine, or micophenolate mofetil and cyclosporine A). The results, shown in the Table, indicate, although without statistical significance, a lower survival rate of the graft and of the patient at 1 and 3 years evolution in group 1, but with superimposable plasma creatinine values. In group 1, unlike group 2, the greatest cause of graft loss was the death of the patient.Table 1The causes of death in group 1 were an infectious process in 4 patients (in 3 the cytomegalovirus was involved) and cardiovascular pathology in 1, during the 3 years of follow-up. We, therefore, believe that older adult uramic patients are a priori good renal transplantation recipients, although the results are somewhat worse than those of younger patients. A viral infection is the main cause of mortality in the first 3 years after transplantation, and, therefore, prophylaxis should be maximized, and the immunodepressive treatment administered should be relaxed. The selection protocol proposed minimizes the cardiovascular pathology in the immediate postoperative period, although it probably affects these patients more severely in subsequent years because of their greater age. R. Solá1 S. Rodríguez Ll. Guirado A. Löpez-Navidad F. Caballero M. Diaz E. Baro D. Paredes