Renal transplantation in the elderly: surgical complications and outcome with special emphasis on the Eurotransplant Senior Programme

Nephrol Dial Transplant. 2008 Jun;23(6):2043-51. doi: 10.1093/ndt/gfm912. Epub 2008 Jan 18.


Background: The purpose of this retrospective study was to evaluate the results of the Eurotransplant Senior Programme (ESP) within our centre compared to elderly recipients >or=60 years from the regular Eurotransplant Kidney Allocation System (ETKAS), specifically focusing on surgical aspects.

Methods: Data from 73 ESP patients (average donor/recipient age: 71.1/67.1) were compared with those from 51 patients (49.7/63.6) treated within the framework of the ETKAS program between the years 1999 and 2006. The mean follow-up was 39.5 months.

Results: Cold ischaemic time (ESP versus ETKAS: 10.3 versus 15.0 h), duration of renal replacement therapy (42.2 versus 76.8 months), donor glomerular filtration rate (81.7 versus 109.9 ml/min/1.73 m(2)) and HLA mismatches (4.1 versus 2.4) were significantly different between the two groups (all P < 0.001). Primary graft function was seen in 74% ESP versus 69% of ETKAS patients (P > 0.05). The rate of surgical complications in the ESP versus ETKAS group was 47% versus 28% (P = 0.031) and the revision rate, 33% versus 24% (P = 0.259). Three-year patient and censored graft survival was 84% versus 92% and 85% versus 88% in the ESP and ETKAS group, respectively (all P > 0.05). Ninety-five percent of all deceased patients died with a functioning graft.

Conclusions: The donor and recipient pool has been markedly expanded through ESP with similar patient and graft survival compared to elderly recipients grafted according to ETKAS criteria. However, patients and their physicians should be aware of the high surgical complication rate in elderly recipients, particularly when receiving elderly donor kidneys. This might seriously influence postoperative patient management but ultimately does not compromise the transplant outcome.

MeSH terms

  • Age Factors
  • Aged
  • Cohort Studies
  • Europe
  • Female
  • Follow-Up Studies
  • Geriatric Assessment*
  • Germany
  • Graft Rejection / mortality*
  • Graft Survival
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / mortality*
  • Male
  • Postoperative Complications / mortality*
  • Postoperative Complications / physiopathology
  • Probability
  • Retrospective Studies
  • Statistics, Nonparametric
  • Survival Analysis
  • Tissue Donors
  • Tissue and Organ Procurement / organization & administration*