International Urology and Nephrology

, Volume 41, Issue 1, pp 195–210

Renal transplantation in the elderly

  • Ramesh Saxena
  • Xueqing Yu
  • Mauricio Giraldo
  • Juan Arenas
  • Miguel Vazquez
  • Christopher Y. Lu
  • Nosratola D. Vaziri
  • Fred G. Silva
  • Xin J. Zhou
Nephrology - Review


Elderly patients are increasingly being considered for kidney transplantation due to a global explosion of the aging population with end-stage renal disease (ESRD). However, mounting scarcity of available organs for transplant has led to a wider disparity between organ supply and demand. Consequently, the criteria for accepting kidneys for transplantation have been extended in an attempt to allow the use of organs from elderly donors or those with significant co-morbidities, so-called “expanded criteria donor” (ECD) kidneys. Excellent outcomes have been achieved from ECD kidneys with appropriate donor and recipient profiling and selection. With increasing recovery efforts directed at older donors, the concept of age-matching is becoming more accepted as a method of optimizing utilization of organs in elderly donors and recipients. Utilization of pulsatile perfusion has further improved ECD outcomes and helped the decision-making process for the UNOS (United Network for Organ Sharing) offer. However, age-related immune dysfunction and associated co-morbidities make the elderly transplant recipients ever more susceptible to complications associated with immunosuppressive agents. Consequently, the elderly population is at a higher risk to develop infections and malignancy in the post-transplant period notwithstanding improved transplant outcomes. Appropriate immunosuppressive agents and dosages should be selected to minimize adverse events while reducing the risk of acute rejections and maximizing patient and renal allograft survival.


Kidney transplantation Senescence Geriatric nephrology Aging Immunosuppression Expanded criteria donor 


  1. 1.
    U.S. Census Bureau International database. Table 094. Midyear population, by age and sex. Available at
  2. 2.
    Zhou XJ, Rakheja D, Yu XQ et al (2008) The aging kidney. Kidney Int 74:710–720. doi:10.1038/ki.2008.319 PubMedCrossRefGoogle Scholar
  3. 3.
    Zhou XJ, Saxena R, Liu Z et al (2008) Renal senescence in 2008: progress and challenges. Int Urol Nephrol 40:823–839. doi:10.1007/s11255-008-9405-0 PubMedCrossRefGoogle Scholar
  4. 4.
    United States Renal Data System (2007) Annual data report. Bethesda, MDGoogle Scholar
  5. 5.
    United Network for Organ Sharing (2006) Annual report.
  6. 6.
    Cecka JM (1996) The UNOS scientific renal transplant registry. In: Cecka JM, Terasaki PI (eds) Clinical transplants. UCLA Tissue Typing Laboratory 1997, Los Angeles, pp 1–14Google Scholar
  7. 7.
    Annual report (1999), UNOS registry (1999), Richmond, VA, United Network for Organ Sharing (1999)Google Scholar
  8. 8.
    Perico N, Ruggenenti P, Scalamogna M et al (2003) Tackling the shortage of donor kidneys: how to use the best that we have. Am J Nephrol 23:245–259. doi:10.1159/000072055 PubMedCrossRefGoogle Scholar
  9. 9.
    Metzger RA, Delmonico FL et al (2003) Expanded criteria donors for kidney transplantation. Am J Transplant 3(Suppl 4):114–125. doi:10.1034/j.1600-6143.3.s4.11.x PubMedCrossRefGoogle Scholar
  10. 10.
    Alexander JW, Vaughn WK (1991) The use of “marginal” donors for organ transplantation. The influence of donor age on outcome. Transplantation 51:135–141. doi:10.1097/00007890-199101000-00021 PubMedCrossRefGoogle Scholar
  11. 11.
    Morris PJ, Johnson RJ, Fuggle SV et al (1999) Analysis of factors that affect outcome of primary cadaveric renal transplantation in the UK. HLA Task Force of the Kidney Advisory Group of the United Kingdom Transplant Support Service Authority (UKTSSA). Lancet 354:1147–1152. doi:10.1016/S0140-6736(99)01104-6 PubMedCrossRefGoogle Scholar
  12. 12.
    Whiting JF (2000) Clinical and economic outcomes of the use of expanded criteria donors in renal transplantation. Semin Dial 13:316–319. doi:10.1046/j.1525-139x.2000.00083.x PubMedCrossRefGoogle Scholar
  13. 13.
    Ojo AO, Hanson JA, Meier-Kriesche H et al (2001) Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 12:589–597PubMedGoogle Scholar
  14. 14.
    Port FK, Bragg-Gresham JL, Metzger RA et al (2002) Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation 74:1281–1286. doi:10.1097/00007890-200211150-00014 PubMedCrossRefGoogle Scholar
  15. 15.
    Gjertson DW (1996) A multi-factor analysis of kidney graft outcomes at one and 5 years posttransplantation: UNOS update. Clin Transplant 10:343–360Google Scholar
  16. 16.
    Basar H, Soran A, Shapiro R et al (1999) Renal transplantation in recipients over the age of 60: the impact of donor age. Transplantation 67:1191–1193. doi:10.1097/00007890-199904270-00019 PubMedCrossRefGoogle Scholar
  17. 17.
    Terasaki PI, Gertson DW, Cecka JM et al (1997) Significance of the donor age effect on kidney transplants. Clin Transplant 11:366–372PubMedGoogle Scholar
  18. 18.
    Meier-Kriesche HU, Cibrik DM, Ojo AO et al (2002) Interaction between donor and recipient age in determining the risk of chronic renal allograft failure. J Am Soc Nephrol 50:195–197Google Scholar
  19. 19.
    Ojo AO, Wolfe RA, Held PJ et al (1997) Delayed graft function: risk factors and implications for renal allograft survival. Transplantation 65:757–758Google Scholar
  20. 20.
    Tullius SG, Reuzel-Selke A, Ergmann F et al (2000) Contribution of prolonged ischemia and donor age to chronic allograft dysfunction. J Am Soc Nephrol 11:1317–1324PubMedGoogle Scholar
  21. 21.
    Collini A, De Bartolomeis C, Ruggieri G et al (2006) Long-term outcome of renal transplantation from marginal donors. Transplant Proc 38:3398–3399. doi:10.1016/j.transproceed.2006.10.055 PubMedCrossRefGoogle Scholar
  22. 22.
    Greenstein SM, Schwartz G, Schechner R et al (2006) Selective use of expanded criteria donors for renal transplantation with good results. Transplant Proc 38:3390–3392. doi:10.1016/j.transproceed.2006.10.062 PubMedCrossRefGoogle Scholar
  23. 23.
    Cecka JM, Terasaki PI (1995) Optimal use for older donor kidneys: older recipients. Transplant Proc 27:801–802PubMedGoogle Scholar
  24. 24.
    Waiser J, Schreiber M, Budde K et al (2000) Age matching in renal transplantation. Nephrol Dial Transplant 15:696–700. doi:10.1093/ndt/15.5.696 PubMedCrossRefGoogle Scholar
  25. 25.
    Stratta RJ, Rohr MS, Sundberg AK et al (2006) Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation: a spectrum or specter of quality? Ann Surg 243:594–603. doi:10.1097/01.sla.0000216302.43776.1a PubMedCrossRefGoogle Scholar
  26. 26.
    Schold JD, Kaplan B et al (2005) The broad spectrum of quality in deceased donor kidneys. Am J Transplant 5:757–765. doi:10.1111/j.1600-6143.2005.00770.x PubMedCrossRefGoogle Scholar
  27. 27.
    Smits JM, Persijn GG, van Houwelingen HC et al (2002) Evaluation of the Eurotransplant Senior Program: the results of the first year. Am J Transplant 2:664–670. doi:10.1034/j.1600-6143.2002.20713.x PubMedCrossRefGoogle Scholar
  28. 28.
    Freia U, Noeldeke J, Machold-Fabriziic V et al (2008) Prospective age-matching in elderly kidney transplant recipients, a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 8:50–57Google Scholar
  29. 29.
    Nyberg SL, Baskin-Bey ES et al (2005) Improving the prediction of donor kidney quality: deceased donor score and resistive indices. Transplantation 80:925–929. doi:10.1097/01.TP.0000173798.04043.AF PubMedCrossRefGoogle Scholar
  30. 30.
    Bunnapradist S, Daswani A et al (2003) Graft survival following living-donor renal transplantation: a comparison of tacrolimus and cyclosporine microemulsion with mycophenolate mofetil and steroids. Transplantation 76:10–15. doi:10.1097/01.TP.0000079965.62765.1A PubMedCrossRefGoogle Scholar
  31. 31.
    Lu AD, Carter JT et al (2000) Outcome in recipients of dual kidney transplants: an analysis of the dual registry patients. Transplantation 69:281–285. doi:10.1097/00007890-200001270-00014 PubMedCrossRefGoogle Scholar
  32. 32.
    Tan JC, Alfrey EJ et al (2004) Dual-kidney transplantation with organs from expanded criteria donors: a long-term follow-up. Transplantation 78:692–696. doi:10.1097/01.TP.0000130452.01521.B1 PubMedCrossRefGoogle Scholar
  33. 33.
    Remuzzi G, Cravedi P et al (2006) Long-term outcome of renal transplantation from older donors. N Engl J Med 354:343–352. doi:10.1056/NEJMoa052891 PubMedCrossRefGoogle Scholar
  34. 34.
    Ruggenenti P, Perico N et al (2006) Ways to boost kidney transplant viability: a real need for the best use of older donors. Am J Transplant 6:2543–2547. doi:10.1111/j.1600-6143.2006.01519.x PubMedCrossRefGoogle Scholar
  35. 35.
    Kainz A, Perco P, Mayer B et al (2007) Gene-expression profiles and age of donor kidney biopsies obtained before transplantation distinguish medium term graft function. Transplantation 83:1048–1054. doi:10.1097/ PubMedCrossRefGoogle Scholar
  36. 36.
    Matsuoka L, Shah T et al (2006) Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation. Am J Transplant 6:1473–1478. doi:10.1111/j.1600-6143.2006.01323.x PubMedCrossRefGoogle Scholar
  37. 37.
    Sung RS, Christinsen LL et al (2008) Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion. Am J Transplant 8:783–792. doi:10.1111/j.1600-6143.2008.02157.x PubMedCrossRefGoogle Scholar
  38. 38.
    Wolfe RA, Ashby VB et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341:1725–1730. doi:10.1056/NEJM199912023412303 PubMedCrossRefGoogle Scholar
  39. 39.
    Oniscu GC, Brown H, Forsythe JL (2005) Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol 16:1859–1865. doi:10.1681/ASN.2004121092 PubMedCrossRefGoogle Scholar
  40. 40.
    Merion R, Ashby VB, Wolfe RA et al (2005) Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA 294:2726–2733. doi:10.1001/jama.294.21.2726 PubMedCrossRefGoogle Scholar
  41. 41.
    Moore PS, Farney AC et al (2007) Experience with deceased donor kidney transplantation in 114 patients over age 60. Surgery 142:514–523PubMedCrossRefGoogle Scholar
  42. 42.
    Debska-Slizien A, Jankowska MM, Wołyniec W et al (2007) A single-center experience of renal transplantation in elderly patients: a paired-kidney analysis. Transplantation 83:1188–1192. doi:10.1097/ CrossRefGoogle Scholar
  43. 43.
    Rao PS, Merion RM et al (2007) Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation 83:1069–1074. doi:10.1097/ PubMedCrossRefGoogle Scholar
  44. 44.
    Macrae J, Friedman AL, Friedman EA et al (2005) Live and deceased donor kidney transplantation in patients aged 75 years and older in the United States. Int Urol Nephrol 37:641–648. doi:10.1007/s11255-004-0010-6 PubMedCrossRefGoogle Scholar
  45. 45.
    Wu C, Shapiro R et al (2008) Kidney transplantation in elderly people: the influence of recipient comorbidity and living kidney donors. J Am Geriatr Soc 56:231–238. doi:10.1111/j.1532-5415.2007.01542.x PubMedCrossRefGoogle Scholar
  46. 46.
    Heldal K, Leivestad T et al (2008) Kidney transplant in the elderly—the Norwegian experience. Nephrol Dial Transplant 23:1026–1031. doi:10.1093/ndt/gfm719 PubMedCrossRefGoogle Scholar
  47. 47.
    Powers DC, Nagel JE, Adler WH (1990) Immunological changes in the elderly. In: Katlic MR (ed) Geriatric surgery: comprehensive care of the elderly. Urban & Schwarzenberg, Baltimore, p 173Google Scholar
  48. 48.
    Ginaldi L, DeMartinis M, D’ Ostilio A et al (1999) Immunological changes in the elderly. Aging 11:281–286 ReviewPubMedGoogle Scholar
  49. 49.
    Globerson A, Effros RB (2000) Aging of lymphocytes and lymphocytes in the aged. Immunol Today 21:515–521. doi:10.1016/S0167-5699(00)01714-X ReviewPubMedCrossRefGoogle Scholar
  50. 50.
    Cossarizza A, Ortolani C, Monti D et al (1997) Cytometric analysis of immunosenescence. Cytometry 27:297–313. doi:10.1002/(SICI)1097-0320(19970401)27:4<297::AID-CYTO1>3.0.CO;2-APubMedCrossRefGoogle Scholar
  51. 51.
    Effros RB (2000) Costimulatory mechanisms in the elderly. Vaccine 18:1661–1665. doi:10.1016/S0264-410X(99)00503-4 PubMedCrossRefGoogle Scholar
  52. 52.
    Vierboom MP, Oseevoort M, Sick EA et al (2003) Induction of allograft tolerance through costimulatory blockade: first selection of drugs in vitro. Transpl Immunol 11:215–222. doi:10.1016/S0966-3274(03)00009-1 PubMedCrossRefGoogle Scholar
  53. 53.
    Fernandez-Gutierrez B, Jover JA, De Miguel S et al (1999) Early lymphocyte activation in elderly humans: impaired T and T-dependent B-cell responses. Exp Gerontol 34:217–229. doi:10.1016/S0531-5565(98)00068-0 PubMedCrossRefGoogle Scholar
  54. 54.
    Pawelec G (1999) Immunosenescence: impact in the young as well as the old? Mech Ageing Dev 108:1. doi:10.1016/S0047-6374(99)00010-X PubMedCrossRefGoogle Scholar
  55. 55.
    Castle SC (2000) Clinical relevance of age-related immune dysfunction. Clin Infect Dis 31:578–585. doi:10.1086/313947 PubMedCrossRefGoogle Scholar
  56. 56.
    Uyemura K, Castle SC, Makinodan T (2002) The frail elderly: role of dendritic cells in the susceptibility to infection. Mech Ageing Dev 123:955–962. doi:10.1016/S0047-6374(02)00033-7 PubMedCrossRefGoogle Scholar
  57. 57.
    Cossarizza A, Monti D, Cantini M et al (1989) Extremely low frequency pulsed electromagnetic fields increase interleukin-2 (IL-2) utilization and IL-2 receptor expression in lymphocytes from old subjects. FEBS Lett 248:141–144. doi:10.1016/0014-5793(89)80449-1 PubMedCrossRefGoogle Scholar
  58. 58.
    Epstein M (1996) Aging and the kidney. J Am Soc Nephrol 7:1106–1122PubMedGoogle Scholar
  59. 59.
    Halloran PF, Melk A, Barth C (1999) Rethinking chronic allograft nephropathy: the concept of accelerated senescence. J Am Soc Nephrol 10:167–181PubMedGoogle Scholar
  60. 60.
    Castle CS, Uyemura K, Crawford W et al (1999) Antigen presenting cell function is enhanced in healthy elderly. Mech Ageing Dev 107:137–145. doi:10.1016/S0047-6374(98)00141-9 PubMedCrossRefGoogle Scholar
  61. 61.
    Sidman CL, Luther EA, Marschall JD et al (1987) Increased expression of major histocompatibility complex antigens on lymphocytes from aged mice. Proc Natl Acad Sci USA 84:7624–7628. doi:10.1073/pnas.84.21.7624 PubMedCrossRefGoogle Scholar
  62. 62.
    Ordemann R, Hutchinson R, Friedman J et al (2002) Enhanced allostimulatory activity of host presenting cells in old mice intensifies acute graft-versus-host disease. J Clin Invest 109:1249–1256PubMedGoogle Scholar
  63. 63.
    Verbeke P, Fonager J, Clark BF et al (2001) Heat shock response and aging: mechanisms and applications. Cell Biol Int 25:845–857. doi:10.1006/cbir.2001.0789 PubMedCrossRefGoogle Scholar
  64. 64.
    Lee YK, Manalo D, Liu AY (1996) Heat shock response, heat shock transcription factor and cell aging. Biol Signals 5:180–191. doi:10.1159/000109187 PubMedCrossRefGoogle Scholar
  65. 65.
    Liu AY, Lee YK, Manalo D et al (1996) Attenuated heat shock transcriptional response in aging: molecular mechanism and implication in the biology of aging. EXS 77:393–408 ReviewPubMedGoogle Scholar
  66. 66.
    Aschcroft GS, Mills SJ, Ashworth JJ (2002) Ageing and wound healing. Biogerontology 3:337–345. doi:10.1023/A:1021399228395 ReviewCrossRefGoogle Scholar
  67. 67.
    Safirstein RL, Bonventre JV (1995) Molecular response to ischemic and nephrotoxic acute renal failure. In: Schlondorff D, Bonventre JV (eds) Molecular nephrology: kidney function in health and disease. Marcel Dekker, New York, p 839Google Scholar
  68. 68.
    Megyesi J, Udvarhelyi N, Safirstein RL et al (1996) The p53-independent activation of transcription of p21 WAF1/CIP1/SDI1 after acute renal failure. Am J Pathol 271:F1211Google Scholar
  69. 69.
    Jassal SV, Opelz G, Cole E (1997) Transplantation in the elderly: a review. Geriatr Nephrol Urol 7:157–165. doi:10.1023/A:1008246129084 PubMedCrossRefGoogle Scholar
  70. 70.
    Brandley BA (2002) Rejection and recipient age. Transpl Immunol 10:125–132. doi:10.1016/S0966-3274(02)00058-8 ReviewCrossRefGoogle Scholar
  71. 71.
    Meier-Kriesche HU, Ojo AO, Cibrik DM et al (2000) Relationship of recipient age and the development of chronic allograft failure. Transplantation 70:306–310. doi:10.1097/00007890-200007270-00012 PubMedCrossRefGoogle Scholar
  72. 72.
    Lufft V, Kliem V, Tusch G et al (2000) Renal transplantation in older adults: is graft survival affected by age? A case control study. Transplantation 69:790–794. doi:10.1097/00007890-200003150-00019 PubMedCrossRefGoogle Scholar
  73. 73.
    Palomar R, Ruiz JC, Zubimendi JA et al (2002) Acute rejection in the elderly recipient: influence of age in the outcome of kidney transplantation. Int Urol Nephrol 33:145–148. doi:10.1023/A:1014470403858 PubMedCrossRefGoogle Scholar
  74. 74.
    Cecka JM (2005) The OPTN/UNOS Renal Transplant Registry. Clin Transpl :1–16Google Scholar
  75. 75.
    Meier-Kriesche HU, Ojo A, Hanson J et al (2000) Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation 69:885–889. doi:10.1097/00007890-200003150-00037 PubMedCrossRefGoogle Scholar
  76. 76.
    Kasiske BL, Chakkera HA, Louis TA et al (2000) A meta analysis of immunosuppression withdrawal trial in renal transplantation. J Am Soc Nephrol 11:1910–1917PubMedGoogle Scholar
  77. 77.
    Meier-Kriesche HU, Srinivas TR, Kaplan B (2001) Interaction between acute rejection and recipient age on long-term renal allograft survival. Transplant Proc 33:3425–3426. doi:10.1016/S0041-1345(01)02477-0 PubMedCrossRefGoogle Scholar
  78. 78.
    Martins PN, Pratschke J, Pascher A et al (2005) Age and immune response in organ transplantation. Transplantation 79:127–132. doi:10.1097/01.TP.0000146258.79425.04 ReviewPubMedCrossRefGoogle Scholar
  79. 79.
    Meier-Kriesche HU, Ojo AO, Cibrik DM et al (2000) Relationship of recipient age and development of chronic allograft failure. Transplantation 70:306–310. doi:10.1097/00007890-200007270-00012 PubMedCrossRefGoogle Scholar
  80. 80.
    Meier-Kriesche HU, Cibrik DM, Ojo AO et al (2002) Interaction between donor and recipient age in determining the risk of chronic renal allograft failure. J Am Geriatr Soc 50:14–17. doi:10.1046/j.1532-5415.2002.50002.x PubMedCrossRefGoogle Scholar
  81. 81.
    Martins PNA, Pratschke J, Pascher A et al (2005) Age and immune response in organ transplantation. Transplantation 79:127–132. doi:10.1097/01.TP.0000146258.79425.04 PubMedCrossRefGoogle Scholar
  82. 82.
    Bagley J, Sawada YW, Iacomini J (2000) A critical role of IL-4 in activating alloreactive CD4 T cells. Nat Immunol 1:257–261. doi:10.1038/79811 PubMedCrossRefGoogle Scholar
  83. 83.
    Carson MJ, Sutcliffe JG (1999) Balancing function vs. self defense: the CNS as an active regulator of immune responses. J Neurosci Res 55:1–8. doi : 10.1002/(SICI)1097-4547(19990101)55:1<1::AID-JNR1>3.0.CO;2-9PubMedCrossRefGoogle Scholar
  84. 84.
    Lou H, Kodama T, Zhao YJ et al (1996) Inhibition of transplant coronary arteriosclerosis in rabbits by chronic estradiol treatment is associated with abolition of MHC II antigen expression. Circulation 94:3355–3361PubMedGoogle Scholar
  85. 85.
    Weidmann P, De Myttenaere-Bursztein S, Maxwell MH et al (1975) Effect of aging on plasma renin and aldosterone in normal man. Kidney Int 8:325–333. doi:10.1038/ki.1975.120 PubMedCrossRefGoogle Scholar
  86. 86.
    Meier-Kriesche HU, Ojo A, Hanson J et al (2001) Exponentially increased risk of infectious death in older renal transplant recipients. Kidney Int 59:1539–1543. doi:10.1046/j.1523-1755.2001.0590041539.x PubMedCrossRefGoogle Scholar
  87. 87.
    Gavazzi G, Krause KH (2002) Ageing and infection. Lancet Infect Dis 2:659–666. doi:10.1016/S1473-3099(02)00437-1 PubMedCrossRefGoogle Scholar
  88. 88.
    Meier-Kriesche HU, Ojo A, Hanson J et al (2000) Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation 69:885–889. doi:10.1097/00007890-200003150-00037 PubMedCrossRefGoogle Scholar
  89. 89.
    Trouillhet I, Benito N, Cervera C et al (2005) Influence of age in renal transplant infections: cases and controls study. Transplantation 80:989–992. doi:10.1097/01.TP.0000173822.05877.D7 PubMedCrossRefGoogle Scholar
  90. 90.
    Meier-Kriesche HU, Friedman G, Jacobs M et al (1999) Infectious complications in geriatric renal transplant patients: comparison of two immunosuppressive protocols. Transplantation 68:1496–1502. doi:10.1097/00007890-199911270-00012 PubMedCrossRefGoogle Scholar
  91. 91.
    Yancik R, Ries LA (2000) Aging and cancer in America: demographics and epidemiologic perspectives. Hematol Oncol Clin North Am 14:17–23. doi:10.1016/S0889-8588(05)70275-6 PubMedCrossRefGoogle Scholar
  92. 92.
    deFitjer JW, Mallat MJ, Doxiadis II et al (2001) Increased immunogenicity and cause of graft loss of old donor kidneys. J Am Soc Nephrol 12:1538–1546Google Scholar
  93. 93.
    Danpanich E, Kasiske BL (1999) Risk factors for cancer in renal transplant recipients. Transplantation 68:1859–1864. doi:10.1097/00007890-199912270-00008 PubMedCrossRefGoogle Scholar
  94. 94.
    Kasiske BL, Snyder JJ, Gilbertson DT et al (2004) Cancer after kidney transplantation in the United States. Am J Transplant 4:905–913. doi:10.1111/j.1600-6143.2004.00450.x PubMedCrossRefGoogle Scholar
  95. 95.
    Vial T, Descotes J (2003) Immunosuppressive drugs and cancer. Toxicology 185:229–240. doi:10.1016/S0300-483X(02)00612-1 PubMedCrossRefGoogle Scholar
  96. 96.
    Kaplan B, Meier-Kriesche HU, Friedman G et al (1999) The effect of renal insufficiency on mycophenolic acid protein binding. J Clin Pharmacol 39:715–720. doi:10.1177/00912709922008353 PubMedCrossRefGoogle Scholar
  97. 97.
    Zeeh J, Platt D (2002) The aging liver: structural and functional changes and their consequences for drug treatment in old age. Gerontology 48:121–127. doi:10.1159/000052829 ReviewPubMedCrossRefGoogle Scholar
  98. 98.
    Morales JM, Campistol JM, Andre’s A et al (2000) Immunosuppression in older renal transplant patients. Drugs Aging 16:279–287. doi:10.2165/00002512-200016040-00004 PubMedCrossRefGoogle Scholar
  99. 99.
    Meier-Kriesche KB (2001) Immunosuppression in elderly renal transplant recipients. Are current regimens too aggressive? Drugs Aging 18:751–759. doi:10.2165/00002512-200118100-00004 PubMedCrossRefGoogle Scholar
  100. 100.
    Danovitch GM, Gill J, Bunnapradist S (2007) Immunosuppression of the elderly kidney transplant recipient. Transplantation 84:285–291. doi:10.1097/ PubMedCrossRefGoogle Scholar
  101. 101.
    Cherikh WS, Kauffman HM, McBride MA et al (2003) Association of the type of induction immunosuppression with posttransplant lymphoproliferative disorder, graft survival, and patient survival after primary kidney transplantation. Transplantation 76:1289–1293. doi:10.1097/01.TP.0000100826.58738.2B PubMedCrossRefGoogle Scholar
  102. 102.
    Brennan DC, Daller JA, Lake KD et al (2006) Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 355:1967–1977. doi:10.1056/NEJMoa060068 PubMedCrossRefGoogle Scholar
  103. 103.
    Lee YK, Manalo D, Liu AK (1996) Heat shock response, heat shock transcription factor and cell aging. Biol Signals 5:180–191. doi:10.1159/000109187 PubMedCrossRefGoogle Scholar
  104. 104.
    Lundgren G, Fehrman R, Gunnarson R et al (1982) Cadaveric renal transplantation in patients over 55 years of age with special emphasis on immunosuppressive therapy. Transplant Proc 14:601–614PubMedGoogle Scholar
  105. 105.
    Spanish Monotherapy Group (1994) Cyclosporine monotherapy versus OKT3 and cyclosporine versus prednisone and cyclosporine as induction therapy in older renal transplant patients: a multicenter randomized study. Transplant Proc 26:2522–2524Google Scholar
  106. 106.
    Hesselink DA, Gregoor PJ, Weimar W (2004) The use of cyclosporine in renal transplantation. Transplant Proc 36:99S. doi:10.1016/j.transproceed.2003.12.047 PubMedCrossRefGoogle Scholar
  107. 107.
    Johnson DW, Nicol DL, Preston JM et al (2003) Use of mycophenolate mofetil in immunosuppressive protocols in elderly renal transplant recipients. Transplantation 76:619. doi:10.1097/01.TP.0000074314.46438.25 PubMedCrossRefGoogle Scholar
  108. 108.
    Sureshkumar KK, Nghiem DD (2003) Use of mycophenolate mofetil in immunosuppressive protocols in elderly renal transplant recipients. Transplantation 76:441–442. doi:10.1097/01.TP.0000074313.67552.46 PubMedCrossRefGoogle Scholar
  109. 109.
    Meier-Kriesche HU, Morris JA, Chu AH et al (2004) Mycophenolate mofetil vs azathioprine in a large population of elderly renal transplant patients. Nephrol Dial Transplant 19:2864–2869. doi:10.1093/ndt/gfh445 PubMedCrossRefGoogle Scholar
  110. 110.
    Meier-Kriesche HU, Li S, Gruessner RW et al (2006) Immunosuppression: evolution in practice and trends, 1994–2004. Am J Transplant 6:1111–1131. doi:10.1111/j.1600-6143.2006.01270.x PubMedCrossRefGoogle Scholar
  111. 111.
    Arbogast H, Huckelheim H, Schneeberger H et al (2005) A calcineurin antagonist-free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: long-term results from a prospective single centre trial. Clin Transplant 19:309–315. doi:10.1111/j.1399-0012.2005.00309.x PubMedCrossRefGoogle Scholar
  112. 112.
    Stangl M, Zerkaulen T, Theodorakis J et al (2001) Influence of brain death on cytokine release in organ donors and renal transplants. Transplant Proc 33:1284–1285. doi:10.1016/S0041-1345(00)02479-9 PubMedCrossRefGoogle Scholar
  113. 113.
    Emparan C, Wolters H, Laukötter M et al (2004) Long-term results of calcineurin-free protocols with basiliximab induction in “old-to-old” programs. Transplant Proc 36:2646–2648. doi:10.1016/j.transproceed.2004.09.045 PubMedCrossRefGoogle Scholar
  114. 114.
    Segoloni GP, Messina M, Squiccimarro G et al (2005) Preferential allocation of marginal kidney allografts to elderly recipients combined with modified immunosuppression gives good results. Transplantation 80:953–958. doi:10.1097/01.TP.0000174134.80947.0A PubMedCrossRefGoogle Scholar
  115. 115.
    Kreis H, Oberbauer R, Campistol JM et al (2004) Long-term benefits with sirolimus-based therapy after early cyclosporine withdrawal. J Am Soc Nephrol 15:809–817. doi:10.1097/01.ASN.0000113248.59077.76 PubMedCrossRefGoogle Scholar
  116. 116.
    Koehl GE, Andrassy J, Guba M et al (2004) Rapamycin protects allografts from rejection while simultaneously attacking tumors in immunosuppressed mice. Transplantation 77:1319–1326. doi:10.1097/00007890-200405150-00002 PubMedCrossRefGoogle Scholar
  117. 117.
    Kahan BD, Yakupoglu YK, Schoenberg L et al (2005) Low incidence of malignancy among sirolimus/cyclosporine-treated renal transplant recipients. Transplantation 80:749–758. doi:10.1097/01.TP.0000173770.42403.F7 PubMedCrossRefGoogle Scholar
  118. 118.
    Stallone G, Schena A, Infante B et al (2005) Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med 352:1317–1323. doi:10.1056/NEJMoa042831 PubMedCrossRefGoogle Scholar
  119. 119.
    Mathew T, Kreis H, Friend P (2004) Two-year incidence of malignancy in sirolimus-treated renal transplant recipients: results from five multicenter studies. Clin Transplant 18:446–449. doi:10.1111/j.1399-0012.2004.00188.x PubMedCrossRefGoogle Scholar
  120. 120.
    Kauffman HM, Cherikh WS, Cheng Y et al (2005) Maintenance immunosuppression with target-of-rapamycin inhibitors is associated with a reduced incidence of de novo malignancies. Transplantation 80:883–889. doi:10.1097/01.TP.0000184006.43152.8D PubMedCrossRefGoogle Scholar
  121. 121.
    United Network for Organ Sharing (2006) Public Forum to Discuss Kidney Allocation Policy Development. 2007

Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Ramesh Saxena
    • 1
  • Xueqing Yu
    • 2
  • Mauricio Giraldo
    • 3
  • Juan Arenas
    • 4
  • Miguel Vazquez
    • 1
  • Christopher Y. Lu
    • 1
  • Nosratola D. Vaziri
    • 5
  • Fred G. Silva
    • 6
  • Xin J. Zhou
    • 1
    • 7
  1. 1.Division of Nephrology, Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
  2. 2.Department of Nephrology, The First Affiliated HospitalSun Yat-Sen UniversityGuangzhouChina
  3. 3.Department of SurgeryEast Texas Medical CenterTylerUSA
  4. 4.Department of SurgeryUT Southwestern Medical CenterDallasUSA
  5. 5.Division of Nephrology & Hypertension, Department of MedicineUC Irvine School of MedicineIrvineUSA
  6. 6.United States and Canadian Academy of PathologyAugustaUSA
  7. 7.Department of PathologyUT Southwestern Medical CenterDallasUSA

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