Transplantation in the elderly: a review.

PURPOSE: 1. To review current knowledge about patient and graft survival, complication rates, patient selection and management protocols in patients aged 60 years or more with a renal transplant. 2. To review the advantages and disadvantages of cadaveric organ retrieval from older donors. DATA SOURCES: Evidence was obtained from published articles identified using a MEDLINE search from 1976 to 1996; expert opinion and citations from previous review articles.
RESULTS: Survival rates have improved with time and now range from 54 to 75% 5-year patient survival and 52-74% 5-year graft survival. The most common reason for graft loss is patient death as both acute and chronic rejection is less commonly seen in older patients. Censored graft survival (if death with a functioning graft is treated as censored data) is higher in elderly patients compared to younger ESRD patients. Based on cohort data from an administrative database a survival advantage is seen in older dialysis patients accepted for transplantation even after matching for comorbidity. Post-transplant morbidity is mainly attributable to infectious complications and an increased prevalence of malignancy. There is insufficient data about the most optimal immunosuppression regime and further research is required in this direction. The evidence currently supports the use of kidneys from older donors because of a relative lack of cadaveric organs from younger donors although a worse patient and graft outcome is recognized in the long term. Insufficient evidence exists to support a firm conclusion regarding age matching or targeting of older organs to special groups.