RENAL TRANSPLANTATION IN ELDERLY PATIENTS OVER 65 YEARS OF AGE: NO MORE A CONTRAINDICATION BUT A GROWING INDICATION.

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P381 Worldwide organ shortage has prompted the nephrological community to extensively use so called “marginal” donors for renal transplantation; ESRD elderly patients, who ask for being inserted in a transplantation waiting list, have dramatically increased over the past decades; so, previous age limits should be reviewed. Aims: to evaluate results of a policy of free (since 1987) acceptance for recipients aged >65 yrs. Methods: 70 cadaveric transplants performed from 05/1987 to 01/2004 are evaluated (dual 21.4%, single 78.6%, M/F 46/24, retransplant 7%). Mean age of donors was 67.5+/-1.5 yrs and mean age of recipients 67.4+/-2.2. Patients are divided in group A (n=67, mean age 66.5+/-1.5, range 65-70 yrs) and group B (n=13, mean age 72.4+/-1.6, range 70-75 yrs). Routine cardiologic tests were myocardial perfusion scintigraphy and/or stress echography. Number of transplants were: 1987-1992 = 4, 1993-1998 = 14, 1999-2003 = 52. Mean follow up was 22.2 months (0.5-158.8). Immunosuppresive protocols were different according to transplantation eras. Basically all patients were on a low steroid regimen and 56% of them withdrew steroids; main immunosuppresant was cyclosporine A in 50% of patients, tacrolimus in 44%, and rapamicine in 6 %; Azathioprine and MMF were sometimes employed to withdraw the calcineurin inhibitor or steroids. Results: patient and graft actuarial survival (Kaplan-Maier estimates and log-rank for significance) at 1, 2, 3, 5,10 yrs were respectively 85, 78, 78, 74, 49% and 82,75, 75, 67, 44%. During the follow up 17 patients died, 14 in group A (11/14 with a functioning graft) and 3 in group B (all with a functioning graft). Causes of death were: 30% cancer, 23% cardiovascular disease, 23% sepsis, 12% cerebro-vascular hemorrhage, 12% meningitis. Cumulative acute rejection rate was 18.6% (17.5% group A and 23% group B); in 2 cases rejection was the cause of graft loss. More frequent complications were: 52% prostatic hypertrophy, 40% urinary tract infections, 16% diabetes, 11% pneumonia, 10% cardiovascular disease (4 acute myocardial infarction and 3 by pass), 7% urologic complications, 6% gastrointestinal medical pathologies, 6% acute pyelonephritis, 4% cancer, 3% abdominal surgical complications. Conclusions: the Authors reinforce their previous opinion in favour of no need of any predefined age barrier in renal transplantation. An age >65 years do not preclude a transplant good outcome. Since elderly patient survival is influenced by age related comorbid conditions, mainly cardiovascular pathologies, cardiovascular assessment is of cardinal relevance. A careful screening before and a tailored immunosuppressive protocol after transplantation, are two main cornerstones. Immunosuppression is a crucial point because on one hand elderly patients are obviously more fragile but on the other hand an immunological hyporesponsiveness towards the transplanted kidney is not yet been demonstrated.

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