The increasing number of patients waiting for a kidney transplant is mainly due to the increase in the number of patients over 65 year old.
Kidney transplantation from cadaveric or living donors confer benefits in terms of improved patient survival in suitably selected elderly recipients. The net gain in survival becomes evident two years after transplantation.
The old for old allocation strategy aims to ensure an appropriate match of kidney and patient life expectancy, simultaneously providing a more immunogenic graft to a less immune-responsive recipient.
The entity of life expectancy gain after transplantation should be evaluated taking into account the improvement in dialysis life expectancy that has been observed in the last years, especially in the elderly patients.
By recognizing who the frail patients are, and by measuring their frailty, we can improve our ability to select older patients for transplantation.
The mostly adopted immunosuppressive regimens for older recipients are not different from those adopted in other patients, at least in the induction phase. The maintenance therapy is kept to the lower limits of standard immunosuppression.
Due to the unfavorable effect of a long dialysis vintage on graft and patient survival, it is important to lead older patients to transplantation with no delays.
It has been demonstrated that kidney transplantation from expanded criteria donor in patients 60 years or older is associated with higher survival rates than remaining on dialysis, whereas living donor renal transplantation is superior to all other options.
Keywords: Kidney transplantation, aging, immunosuppressive agents, frailty