Bootcongres

Introduction: In the last decade, increasing numbers of elderly kidney donors and recipients have been accepted in our center. Is it relatively more advantageous for elderly recipients to receive a kidney from a young and/or living donor compared to young recipients?

Methods: Between 1-1-2002 and 31-12-2012, 1565 kidney transplants were performed; 545 patients received a deceased donor (DD) and 1020 a living donor (LD) kidney transplantation. N=359 recipients were younger than 40 years (76% LD), n=716 were between 40 and 60 (65% LD) and n=490 were older than 60 years (57% LD). Transplant year was categorized into 3 categories; 1) between 2002 and 2006 (n=427), 2) between 2006 and 2010 (n=571) or 3) transplanted between 2010 and 2012 (n=567). In Cox multivariate analysis we tested donor and recipient age, transplant year and donor type to determine their effect on patient and graft survival censored for death.

Results: The percentage transplanted with a LD was the lowest in the eldest recipient age group (p<0.001). The percentage LD transplantations increased in the 3 time categories in all age categories: Youngest 69%, 74% and 85%; intermediate age group: 57%, 67% and 70%; oldest age group: 43%, 58% and 63% respectively. In Cox analysis age and transplant year were tested as continuous variables. Recipient age (p<0.01) and donor type (p=0.003) had significant influence on patient survival (162 deaths). Recipient age, donor age and donor type had a significant influence (all p<0.001) on graft survival censored for death (249 events), in multivariate analysis. There was no interaction between recipient and donor age, between recipient age and donor type and between donor age and donor type. This means that the influence of donor age was independent of recipient age. The favorable influence of LD transplantation is neither different between young and old recipients, nor between young and old donors.

Conclusion: The advantages of LD transplantation and transplantation of young donor organs is not different for old recipients compared to young recipients. Though LD transplantation numbers increase in time in all recipient populations, older recipients lag behind. The best way to improve results in the elderly population is to increase LD transplantation in this population.