Cadaveric renal transplantation in elderly recipients: is it worthwhile?

The aim of this study is to analyse whether or not old age alone significantly affects the outcome of patient and graft survival in cadaveric renal transplantation, and thus whether it should be a selection criterion for induction into transplant programmes, given the current shortfall in donor organs in the United Kingdom. Data is presented on all 307 solitary cadaveric renal allografts performed at Addenbrooke's Hospital, Cambridge between January 1983 and December 1987. Patients are divided into those aged less than 60 years (n = 243) and those aged 60 years and over (n = 45) at the time of transplantation. There is no significant difference in graft survival between the two groups (60.3% and 62.2%) at 18-60 months (mean 42 months) post-transplantation. Patient survival in the two groups is significantly different (83% and 64.4%, P less than 0.01) at the same point. Causes of graft loss, death, and end-stage renal failure are analysed. It is suggested that patients aged 60 years and over may require less immunosuppression but that graft loss from rejection in this group has a high associated mortality. We conclude that cadaveric renal transplantation in the elderly should only be undertaken after careful selection, paying particular attention to evidence of cardiovascular disease and full counselling of the risk of death with these patients.