a 161-year-old case of renal transplantation

Case Reports

A 161-YEAR-OLD CASE OF RENAL TRANSPLANTATION

H. R. H. PATEL, N. JENKINS, M. ARYA, G. H. NEILD AND R. NAUTH-MISIRFrom the Institute of Urology and Nephrology, University College London, London, England

KEY WORDS: kidney, transplantation, aging

Renal transplantation in all age groups is well documentedbut has rarely been performed in recipients older than 75years. There are older people who have negligible comorbid-ity and lead active lifestyles. This fact has provoked muchdebate about geriatric renal transplant with ongoing ethicaldiscussions concerning elderly people being denied renaltransplant, and the possible use of the aged population as asource of renal allografts.1 We report on the oldest recordedrecipient (82 years old) and donor (79 years old) combinationto date with a combined age of 161 years.

CASE REPORT

An 82-year-old man, who believed that hemodialysis lim-ited his lifestyle extensively, was offered a renal allograftfrom a 79-year-old donor with subarachnoid hemorrhage.The donor had no significant comorbidity. There was nosuggestion of renal impairment at the time of retrieval.There was ABO blood group compatibility and a 2:1:1 HLAmismatch with the donor.

Cold ischemic time was 24 hours. The kidney functionedimmediately. The patient was discharged from the hospitalon primary immunosuppression, including 5 mg. pred-nisolone daily and 3 mg. tacrolimus daily, 10 days later withgood renal function (creatinine 1.4 mg./dl.). Acute rejectionoccurred 2 weeks later which was treated successfully with

intravenous methylprednisolone. At 1-year followup renalfunction was stable, and the glomerular filtration rate (21 ml.per minute per 1.73 m.2) and creatinine (2.2 mg./dl.) werenormal.

DISCUSSION

It has been demonstrated that cadaveric renal transplan-tation from young donors to young recipients or young donorsto old recipients has better success rates than from old donorsto young recipients.2 However, due to a shortage of cadavericdonors and an increase in demand, the use of older donors isinevitable. In 1998 in the United States 28% of all cadaverickidney transplants were from donors older than 50 years.3HLA compatibility between donor and recipient has thegreatest influence on the long-term success of renal allograftsbut recent advances in immunosuppressive regimens haveimproved graft survival in all age groups, including thosefrom donors older than 60 years. Our case emphasizes thepotential for the use of older donors and recipients.

REFERENCES

1. Ponticelli, C.: Should renal transplantation be offered to olderpatients? Nephrol Dial Transplant, 15: 315, 2000

2. Waiser, J., Schreiber, M., Budde, K. et al: Age-matching in renaltransplantation. Nephrol Dial Transplant, 15: 696, 2000

3. United Network for Organ Sharing (UNOS): www.unos.org/Newsroom/critdata_main.htm. Last accessed August 2000Accepted for publication October 13, 2000.

0022-5347/01/1653-0890/0THE JOURNAL OF UROLOGY® Vol. 165, 890, March 2001Copyright © 2001 by AMERICAN UROLOGICAL ASSOCIATION, INC.® Printed in U.S.A.

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