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

Abstract

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.

Keywords

Kidney transplantation Senescence Geriatric nephrology Aging Immunosuppression Expanded criteria donor 

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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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