Résumé
From April 1988 to August 1993, 57 elderly recipients more than 60 years old (mean age 64 +/- 3 years, 35 males, 22 females) underwent cadaveric renal transplantation. The pretransplant screening included immunological and viral status and urological examination; cardiovascular risk factors were systematically estimated by medical history, physical examination, echocardiography, femoral arterial doppler, and myocardial stress thallium imaging. A coronarography was performed if myocardial ischemia was evidenced. Patients free of cardiovascular diseases or after correction of vascular and/or coronary lesions were included in the waiting list. A sequential immunosuppression regimen including azathioprine, prednisolone anad antilymphocyte globulins was given in all patients. Oral cyclosporin A (5-8 mg/kg/day) was started when serum creatinine level decreased to 200 mumol/l; antilymphocyte globulins were stopped when whole trough blood cyclosporin level reached 150-200 ng/ml. After 24 months of follow-up, the patient survival rate of elderly recipients was significantly lower than the survival rate observed in patients less than 60 years old (90% vs 97%; p < 0.005); the deaths were related to cardiovascular complications in 3 cases and to infectious diseases in 3 cases. No abdominal complications were observed in our series. The graft survival was identical in both groups (81% vs 82% at 2 years), and we observed a low incidence of acute rejection (23%) in the elderly group. The graft function, as determined by serum creatinine level, is significantly correlated with the donor age (p < 0.05). We conclude that the patients more than 60 years old, free of ischemic coronary disease or after correction of such a lesion could be safely transplanted.From April 1988 to August 1993, 57 elderly recipients more than 60 years old (mean age 64 +/- 3 years, 35 males, 22 females) underwent cadaveric renal transplantation. The pretransplant screening included immunological and viral status and urological examination; cardiovascular risk factors were systematically estimated by medical history, physical examination, echocardiography, femoral arterial doppler, and myocardial stress thallium imaging. A coronarography was performed if myocardial ischemia was evidenced. Patients free of cardiovascular diseases or after correction of vascular and/or coronary lesions were included in the waiting list. A sequential immunosuppression regimen including azathioprine, prednisolone anad antilymphocyte globulins was given in all patients. Oral cyclosporin A (5-8 mg/kg/day) was started when serum creatinine level decreased to 200 mumol/l; antilymphocyte globulins were stopped when whole trough blood cyclosporin level reached 150-200 ng/ml. After 24 months of follow-up, the patient survival rate of elderly recipients was significantly lower than the survival rate observed in patients less than 60 years old (90% vs 97%; p < 0.005); the deaths were related to cardiovascular complications in 3 cases and to infectious diseases in 3 cases. No abdominal complications were observed in our series. The graft survival was identical in both groups (81% vs 82% at 2 years), and we observed a low incidence of acute rejection (23%) in the elderly group. The graft function, as determined by serum creatinine level, is significantly correlated with the donor age (p < 0.05). We conclude that the patients more than 60 years old, free of ischemic coronary disease or after correction of such a lesion could be safely transplanted.