Introduction Elderly patients (age over 65) now represent the largest population starting renal replacement therapy. However their access to, and benefit from, transplantation remains unclear. This study examines donor profile and outcomes in elderly patients listed for renal transplantation in our centre, where twice as many DCD as DBD kidney transplants are now performed.

Methods A retrospective case review of all adult patients listed for renal transplantation between August 2002 and July 2012. DBD were allocated according to the UK national allocation scheme; DCD were allocated locally using the same algorithm. For the initial analysis, elderly patients (>65 years) were compared to a younger cohort (<45 years).

Results 1491 patients were listed in total; 167 (11%) were over 65 and 551 (37%) were under 45. The number of elderly patients listed per year increased from 8 (6.4% of annual total) in 2002 to 25 (16.5%) in 2012. Removal from the waiting list (death or development of comorbidity) occurred more frequently in the elderly (26%) than the young (5%, p<0.01). Only 5% of elderly patients listed in the first 6 years remain active, compared with 31% of the younger group; Kaplan-Meier analysis confirmed that median time to de-listing is much shorter in the elderly group (897 vs 2027 days; log rank p<0.01).

49% of the elderly and 71% of the younger cohort received a transplant. Times from listing to transplantation were similar in both groups (elderly; median 424 days vs. young; 388 days) but notably, the elderly received a much higher proportion of DCD kidneys (Fig. 1). Elderly patients generally received kidneys from elderly donors (median donor age 61 vs. 43 years (p<0.001); this held true for DCD kidneys (68 vs. 41, p<0.001). Graft survival was similar in the two age groups (1yr survival 91.4 vs. 98.1%; log rank p=0.66) and in both, transplantation offered a significant survival advantage (92% 3yr survival from listing for those transplanted in >65 group; cf 85% those not, log rank p<0.05) (Fig. 2).

Conclusions The time-frame for transplantation of elderly patients is limited. As numbers listed increase, greater use of elderly DCD donors may alleviate demand, yet still provide survival advantage.

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