Renal transplantation in older patients: the University of Toronto experience

One thousand and eighteen patients who received first cadaveric renal transplants (age 18–80 yr) at the University of Toronto from 1981–1991 were reviewed in order to compare the results of patients older than 55 years of age (n=251) with the rest of the group (n=767). One- and 5-year graft survival were significantly lower in patients over 55 years of age compared to younger patients; 74% vs. 82% at one year and 49% vs. 75% at 5 years (p<0.0005) respectively. Multivariate analysis confirmed a reduced odds ratio of rejection in patients over 55 of 0.5 (P<0.001). There was no significant difference between the two groups with respect to rejection as a cause of graft failure (16% in those less than 55 vs. 16% in older than 55 vs. 9% in younger patients (p<0.005). Actuarial patient survival was significantly less in patients over 55 years of age −85% at one year and 65% at 5 years vs. 95% at 1 year and 90% at 5 years (p<0.0005). Multivariate analysis conformed age as an independent risk factor for graft loss (relative risk 1.94,P<0.001), death (relative risk 4.75,P<0.001), and graft loss due to death (relative risk 6.28,P<0.001). These data emphasize the importance of death as a cause of graft loss in older patients.