[Kidney transplantation in patients more than 60 years old. Analysis of results apropos of 57 patients]

From April 1988 to August 1993, 57 elderly recipients more than 60 years old (mean age 64 +/- 3 years, 35 males, 22 females) underwent cadaveric renal transplantation. The pretransplant screening included immunological and viral status and urological examination; cardiovascular risk factors were systematically estimated by medical history, physical examination, echocardiography, femoral arterial doppler, and myocardial stress thallium imaging. A coronarography was performed if myocardial ischemia was evidenced. Patients free of cardiovascular diseases or after correction of vascular and/or coronary lesions were included in the waiting list. A sequential immunosuppression regimen including azathioprine, prednisolone anad antilymphocyte globulins was given in all patients. Oral cyclosporin A (5-8 mg/kg/day) was started when serum creatinine level decreased to 200 mumol/l; antilymphocyte globulins were stopped when whole trough blood cyclosporin level reached 150-200 ng/ml. After 24 months of follow-up, the patient survival rate of elderly recipients was significantly lower than the survival rate observed in patients less than 60 years old (90% vs 97%; p0.005); the deaths were related to cardiovascular complications in 3 cases and to infectious diseases in 3 cases. No abdominal complications were observed in our series. The graft survival was identical in both groups (81% vs 82% at 2 years), and we observed a low incidence of acute rejection (23%) in the elderly group. The graft function, as determined by serum creatinine level, is significantly correlated with the donor age (p0.05). We conclude that the patients more than 60 years old, free of ischemic coronary disease or after correction of such a lesion could be safely transplanted.(ABSTRACT TRUNCATED AT 250 WORDS)