Transplantation rénale chez le patient âgé de plus de 60 ans

Renal transplantation may be an interesting option in elderly patients, since most studies confer a greater survival benefit compared with dialysis, and improve overall quality of life. However, a comprehensive preoperative evaluation of the prospective older adult recipient is imperative because of the increased risk of perioperative mortality. The three main causes of mortality following transplantation are cardiovascular diseases, infection and neoplasia. Conversely, older patients have a decreased likelihood of immunologic rejection, and should have a low immunosuppression level. Kidney procurement from older adults with expanded criteria (age over 60, associated with vascular disease) improves the paucity of available organs. Older kidneys may be allocated into single or dual transplantation. Even if allograft survival from older donors is shorter compared to younger donors, it remains sufficient if we consider the life expectancy of elderly patients with end-stage renal disease. Living donor transplantation should always be considered, because it ensures better vital prognosis compared to deceased donor transplantation.