Outcomes following renal transplantation in older renal transplant recipients: a single-center experience and “Croatian senior program”

Outcomes of kidney transplantation in older patients have not, however, been fully defined. The aims of this study were to analyze the number of new end-stage renal disease (ESRD) patients ≥65 years of age who were managed with kidney transplantation and their survival through the study period. In addition, we have analyzed post-transplantation outcomes in younger and older renal transplant recipients (RTRs).

We have analyzed the mean age of 505 RTRs transplanted between January 1990 and December 2013. Older people were defined as aging 65 years or older. Of 505 RTRs, there were 73 (14.5 %) patients who were ≥65 years of age. Therefore, in further analysis, patients were divided into two subgroups: younger recipients (younger than 65 years) and older recipients (aging 65 years or older).

In the period from 1990 to 2001, patients who were 65 years of age and older were only sporadically treated with kidney transplantation in Croatia. Since 2002, the number of patients older than 65 years undergoing renal transplantation has been increasing. The older recipients were more likely to receive organs from older donors (52.6 ± 16.8 vs. 45.8 ± 13.2; p = 0.0001). There were no significant differences due to HLA mismatch between the two groups of analyzed patients. There was no difference in the rates of DGF between the older and younger recipients. Older recipients were less likely than younger recipients to have acute rejection crisis during the first-ear after transplantation (16.4 vs. 34.7 %; p = 0.03). There were no significant differences due to readmission rates in the first-year post-transplantation between the two groups. There was no significant difference due to graft function and 1-year graft and patient's survival between young and older recipients. Serum creatinine values at 1 year were higher in older recipients who received kidneys from elderly donor.

Our experience supports the use of kidney transplantation in the population of older ESRD patients. We can increase patients and graft survivals in elderly individuals with careful pre-transplant evaluation and HLA matching. “Croatian senior program” that includes HLA matching represents a good approach for kidney transplantation in older ESRD patients.