Evaluation of 84 elderly donors in renal transplantation In recent years there has been a shift in age distribution toward a larger percentage of older donors in organ transplantation worldwide. UNOS data show that the percentage of donors over 50 has doubled in the last 10 years (1). In Italy, according to the National Transplant Organiza- tion, 25% of the kidneys transplanted between 2000 and 2001 were from cadaveric donors over 60 yr old, and the percentage was as high as 36% in our own programme at the University of Padua (2). The two reasons for this trend are the decrease in fatal traumatic closed-head injuries as a consequence of laws making crash helmets, seat- belts and airbags mandatory, and – more import- ant – the more flexible donor selection criteria adopted in order to increase the number of organs available. Unfortunately, this situation has a negative impact on transplant results. In fact, several reports have shown that donor age significantly affects kidney graft survival (3, 4). The reduction in nephron mass and functional reserve of the elderly kidney makes it more susceptible to immunological assault, ischemic insult and drug toxicity. Rigotti P, Baldan N, Valente M, Scappin S, Furian L, Cadrobbi R, Marchini F, Ancona E. Evaluation of 84 elderly donors in renal transplantation. Clin Transplant 2004: 18: 440–445. ª Blackwell Munksgaard, 2004 Abstract: Background: The use of elderly donors (ED) and dual kidney transplantation (DKT) procedures have become common in clinical prac- tice. A correct evaluation of kidneys from ED is crucial to avoid unsuc- cessful transplantation or the use of DKT when a single transplant (ST) would be equally successful. The aim of this investigation was to assess the role of renal biopsy (RB) in the assessment of kidneys from ED. Patients and methods: A total of 84 ED aged ‡ 60 yr were evaluated. In 19 cases, the kidneys were not used, mainly because of atherosclerotic vascular lesions. A histological score (HS) from 0 to 12 was awarded, considering the proportion of glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arterial and arteriolar narrowing. On the basis of the HS, 37 donors were selected for 40 ST and 21 for DKT, three were discarded. All recipients received triple-drug therapy based on calcineurin inhibitors, mycophenolate mofetil and steroids. Results: Primary non-function was observed in three of 40 ST and one of 21 DKT. Acute tubular necrosis occurred in 22/40 ST and in 11/21 DKT. Acute rejection occurred in 16/40 ST and four of 21 DKT. Renal function was satisfactory in both groups, with 1-yr S-Cr ¼ 171 umol/L and 137 umol/L, respectively in the ST and DKT groups. One-year patient survival was 92% in ST and 100% in DKT; 1-yr graft function was 87% in ST and 95% in DKT. Conclusion: The histological assessment of kidneys from ED enables a correct selection of kidneys for ST or DKT and prevents the transplantation of high-risk kidneys. Paolo Rigotti a , Nicola Baldan a , Marialuisa Valente b , Sabrina Scappin a , Lucrezia Furian a , Roberto Cadrobbi a , Francesco Marchini c , Ermanno Ancona a a Clinica Chirurgica 3, Department of Medical and Surgical Sciences, University of Padua, b Institute of Pathological Anatomy, University of Padua and c Division of Nephrology, Padua General Hospital, Padova, Italy Key words: elderly donors – kidney transplantation – renal biopsy Corresponding author: Paolo Rigotti MD, Associate Professor of Surgery, Clinica Chirurgica 3, Department of Medical and Surgical Sciences, University of Padua, Ospedale Giustinianeo, Via Giustiniani, 2 - 35128 Padova, Italy. Tel.: +39 049 8213173; fax: +39 049 8213152; e-mail: traprepa@unipd.it Accepted for publication 3 December 2003 Clin Transplant 2004: 18: 440–445 DOI: 10.1111/j.1399-0012.2004.00186.x Copyright ª Blackwell Munksgaard 2004 440