Background: Living donor kidney transplantation recipients with older donors often have lower GFR than whom with young donors after transplantation. Calcineurin inhibitor (CNI) may cause nephrotoxicity, especially in recipients with older donors. The aim of this study is to investigate efficacy and safety of CNI withdrawal in living donor kidney transplantation recipients with older donors.

Methods: 83 cases of living donor kidney transplantation with donor's age more than 50 years old were collected from Jan 2004 to Dec 2009. Among these recipients, 25 cases withdrew CNI and transferred to rapamycin at the end of 3 months after kidney transplantation, while 58 cases maintained CNI usage after 3 months. Baseline characters, complications, graft function, graft and patient survival were compared between these two groups.

Results: Donor age, recipient age, body weight, HLA mismatching, DGF and acute rejection rate, serum creatinine and eGFR were comparable between these two groups at the end of 3 months after kidney transplantation. The 1-year serum creatinine were 111.8±25.5¯o;mol/L in CNI withdrawal group, and 132.5±35.9¯o;mol/L in CNI maintained group (p=0.013). The 1-year eGFR were 86.9±8.2 ml/min in CNI withdrawal group, and 77.4±7.2 ml/min in CNI maintained group (p< 0.001). The 3-year eGFR were 76.1±7.8 ml/min in CNI withdrawal group, and 67.0±6.4 ml/min in CNI maintained group (p< 0.001). The acute rejection rate were 24% vs. 22.4%, and chronic rejection rate were 4.0% vs. 10.3%, respectively (P>0.05). 1 patient (4.0%) lost graft function in CNI withdrawal group, in contrast 4 patients (6.9%) lost graft function in CNI maintained group (P>0.05). There were no differences of 1-, 3-, 5- year graft survival and patient survival between these two groups.

Conclusion: CNI withdrawal is safe and can improve graft function in living donor kidney transplantation with older donors.

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