Kidney transplantation from older living donors

Abstract

Recently, living donor kidney transplantation has become a suitable therapeutic option for many elderly patients with ESRD. In this setting, the living donor will often be an equally elderly subject. This entails a process of selection that is complex and not always well codified.

Elderly donors (EDs) are aged between 65 and 80. In EDs, the minimum glomerular filtration rate (GFR) acceptable for donation decreases with increasing age, but according to the KDIGO guidelines it should never be less than 60 ml / min / 1.73m2. However, the United Kingdom Guidelines also accept slightly lower values.

After donation, also in the elderly there is an increase in the volume of the residual kidney and an increase in GFR of about 20% (mainly due to increased renal plasma flow). This allows maintaining a stable GFR over time, without an increased risk of ESRD.

For GFR evaluation, the suggested formulas are CKD-EPI or MDRD. However, creatinine clearance, although little considered by the guidelines, in the elderly may be reliable, and is still widely used.

Graft survival from EDs may be lower to those from younger donors but as high as those from standard deceased donors

The selection of the donor requires many other investigations. In the elderly, unlike in the young, it may be difficult to distinguish between a pathological or a para-physiological result. In order to correctly interpret these conditions, it is necessary to have great experience and expertise that only transplant centers with a high volume of activity can guarantee

 

Keywords: living donor, elderly donor, kidney transplantation

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Introduzione

Da alcuni anni, Il trapianto di rene da donatore vivente è in progressiva crescita anche in Italia. I dati del SIT (Sistema Informativo Trapianto) documentano 191 trapianti da donatore vivente effettuati nel 2010, aumentati a 302 nel 2015. Oggi, il trapianto da donatore vivente rappresenta il 20% di tutti i trapianti di rene effettuati in un anno in Italia. Una percentuale che tutti auspichiamo possa crescere nei prossimi anni. 

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