1. BUONA FUNZIONE RENALE DEI TRAPIANTI RENALI DA DONATORI ANZIANI VALUTATI CON CLEARANCE DELLA CREATININA SECONDO GAULT-COCKCROFT, CON DATI ECOGRAFICI E CON VALUTAZIONE CHIRURGICA
Elisabetta Bertoni, Lorenzo Di Maria, Alberto Rosati, Maria Zanazzi, Rosa Piperno, Luciano Moscarelli, Maurizio Salvadori
Unità Operativa Nefrologia-Dialisi-Trapianto Renale
Ospedale di Careggi- Firenze

2. COUNTS OF CADAVER RENAL TRANSPLANTS BY RECIPIENT AGE AND YEAR OF TRANSPLANT (USRDS DATA)

4. ALL DONORS AND OVER 50th YEARS DONORS BY YEAR

5. TREND OF DONOR AGE IN RECENT YEARS (%) DONOR 1997 15. 43 P. M. P
TREND OF DONOR AGE IN RECENT YEARS (%) DONOR P.M.P. DONOR P.M.P.

6. TREND OF DONOR AGE IN RECENT YEARS (NUMBER) DONOR 1997 15. 43 P. M. P
TREND OF DONOR AGE IN RECENT YEARS (NUMBER) DONOR P.M.P. DONOR P.M.P.

7. THE USE OF OLDER KIDNEY DONORS
Use of older cadaveric and living donor kidneys for transplantation can alleviate the donor shortage
However, transplantation of kidneys from older donors, especially cadaveric, is associated with higher incidence of DGF,higher discharge serum creatinine, higher rejection rate and lower patient and graft survival
The practice of preferentially transplanting the older donor kidney into the elderly recipient is increasing, but may further worsen the odds of successful transplantation in this already high-risk population
The use of older donor kidneys warrants careful assessment of the extent of age-related pathological changes and measures to decrease the incidence of DGF
The benefits of double kidney transplantation from the older cadaveric donor need to be explored further

8. FUNCTIONAL EVALUATION OF OLDER DONOR KIDNEYS
Use of kidneys from older cadaver donors for renal transplantation
Wyner et al. Urology,1993
Utilization of the older donor for renal transplantation
Kuo et al. Am J Surg, 1996
Predictability of creatinine clearance estimates in critically ill patients
Robert et al. Crit Care Med, 1993
When should expanded criteria donor kidneys be used for single vs dual kidney transplant
Alfrey et al. Transplantation,1997

9. SEMI-QUANTITATIVE SCALE FOR RENAL BIOPSY SCORING (Karpinski et al
SEMI-QUANTITATIVE SCALE FOR RENAL BIOPSY SCORING (Karpinski et al.Transplantation 67,1999)
Interstitial score
0= absent
1= <20% of cortical parenchyma replaced by fibrous connective tissue
2= 20-50% of cortical parenchyma replaced by fibrous connective tissue
3= >50% of cortical parenchyna replaced by fibrous connective tissue
Vascular score
Arteriolar narrowing
Arterial sclerosis
Glomerular score
0= no globally sclerosed glomeruli
1= <20% global glomerulosclerosis
2= 20-50% global glomerulosclerosis
3= >50% global glomerulosclerosis
Tubular score
0= absent
1= <20% of tubules affected
2= 20-50% of tubules affected
3= >50% of tubules affected

10. AIM OF THE STUDY
Aim of this study is to verify the graft outcome of kidneys retrieved from donor aged >55 years, judged suitable for transplantation basing on donor serum creatinine, donor estimated creatinine clearance by Gault-Cockcroft, ultrasonography and surgical inspection after retrieval

11. DONOR CHARACTERISTICS
Number
Gender (M / F) 30/36
Cause of death (T / CVA) 21/45
Age (years) 5.1
Cold Ischemia Time (hrs) 5.7

12. OLDER DONOR DISTRIBUTION ACCORDING TO THE DONOR AGE

13.  AGE BETWEEN DONORS AND RECIPIENTS
Mean recipient age 51.019.66 ; mean donor age 59.975.1 ; p<0.0001

14. MEAN DONOR SERUM CREATININE AND CREATININE CLEARANCE ACCORDING GAULT-COCKCROFT

15. INCIDENCE OF DELAYED GRAFT FUNCTION ACCORDING TO THE DONOR AGE
P<0.0001
28/66
35/165

16. RELATIONSHIP BETWEEN DONOR ESTIMATED CREATININE CLEARANCE AND RECIPIENT SERUM CREATININE LEVELS AT 3 MONTHS
P<0.01

17. ONE YEAR SERUM CREATININE OF KIDNEY RECIPIENTS FROM DONORS OVER 55 YEARS VS CONTROLS

18. RECIPIENT THREE YEARS SURVIVAL RATES (RECIPIENTS FROM DONORS >55 VS RECIPIENTS FROM DONORS <55)
P<

19. THREE YEARS GRAFT SURVIVAL RATES (DONORS > 55 YEARS VS DONORS < 55 YEARS)
p=0.001

20. THREE YEARS GRAFT SURVIVAL RATES (DONORS > 55 YEARS VS DONORS > 55 YEARS) CENSORED FOR PATIENTS DIED WITH FUNCTIONING KIDNEYS
P= 0.02

21. ONE AND THREE YEARS GRAFT SURVIVAL IN KIDNEY RECIPIENTS FROM DONORS OVER 55 YEARS

22. CONCLUSION I
Old patients waiting for a kidney transplantation are increasing widely in the waiting lists.
Old donors suitable for kidney transplantation are increasing as well.
One of the most crucial issues is the evaluation of kidneys retrieved from old donors, so to establish their suitability for transplantation.

23. CONCLUSION II
Donor renal pathology may be useful in predicting the graft outcome.
Nevertheless the kidney morphologic evaluation should be performed in a short time and by expert pathologists.
Donor renal calculated function is equally useful in predicting the graft outcome

24. CONCLUSION III
We report the graft outcome of 66 renal transplantation with kidneys from donors over 55 years.
The kidney suitability for transplantation was evaluated on functional basis, on ultrasonography data and on the surgical inspection at the retrieval

25. CONCLUSION IV
Our data regarding the use of older donors show a 1 and 3 years graft survival rate similar or even higher respect to the series of Eurotransplant and UNOS.
These data document that kidneys from donors older than 55 years can be safely used basing on functional parameters, also independently from pretransplant morphological evaluation