Introduction and Objectives: Kidney transplantation is associated, in all age ranges, with better quality of life and, longer survival in comparison with dialysis. Moreover, there has been an increase in the number of donors of over 65 years of age, died due to a cerebrovascular accident. Although, kidney transplantation from elderly donors may show worse outcomes; kidneys from elderly donors may be used for older recipients whose lower life expectancy would compensate for potential the lower survival rate of the grafts. Our purpose was to analyze the outcomes of kidney transplantation comparing donors younger and older than 65 years old and, those extremely old donors (> 80 years old).
Material and Methods: A retrospective study was carried out evaluating complications and functional outcomes of kidney transplantation from donors younger than 65 years old in comparison with those older than 65 years old. Donors older than 80 years old were analyzed independently as they constitute a group of extremely old donors. Our review included kidney transplants performed in our center between 2006 and 2015.
Results: 1538 kidney transplantations were evaluated, 69.2% using grafts from donors younger than 65 years old, 26.5% older than 65 years old and, 4,3 grafts were from donors older than 80 years. The cause of death was due to a cerebrovascular accident or heart attack in 60.5% and 76.5% among donors younger and older donors, respectively.
The percentage of grafts with primary non-function were 5.1%, 10.6% and 17.7% for donors <65, 65-79 and ≥80 years, respectively (p<0.001). The percentage of grafts with delayed graft function were 51.5% and 54.7% for donors <65 and  ≥65 years (p=0.187). The percentage of patients with complications after transplantation were 50.8%, 60.3% and 65.6% among recipients with grafts from donors <65, 65-79 and ≥80 years. Ureteral fistula was reported in 3.3%, 7.3% and 12.9% for each group. The percentage of venous thrombosis was 1.7% for grafts <65, 4.5% for those ≥65 and ≤79 and 9.7% for those >80 years. Arterial thrombosis was reported in 1.1%, 3.3% and 4.8% for each group. The incidence of surgical site infection was 7.8% for grafts <65, 14.9% for those ≥65 and ≤79 and 14.5% for those >80 years.
Conclusions: Kidneys from older donors have shown a higher incidence of primary non-function and a higher rate of post-operative complications, such as grafts thrombosis, that may be related to more frequent atherosclerotic changes in renal and iliac arteries.