Introduction: Patients aged 60 years and older stand for the fastest growing group of patients with end-stage renal disease worldwide, and the need for kidney transplants among this population is rising. In Japan, living donor kidney transplantation is mainly performed to deal with the severe shortage of deceased donors, and the number of spousal transplants is currently increasing. Patients and Methods: A total of 164 patients with ESRD underwent living donor kidney transplantation at our institution, of whom 21 patients aged 60 years and older had spousal kidney transplantation. ABO-incompatible kidney transplantation was performed in 5 of the 21 cases. We analyzed these recipients. Results: Patient and graft survival rates were 100%. The incidence of acute rejection was 23.8%. Eight patients experienced cytomegalovirus viremia, two patients experienced Pneumocystis jiroveci infection, and one experienced bacterial pneumonia. Two patients developed cancers and underwent curative operation after transplantation. Conclusions: Elderly kidney transplantation from spousal donors is associated with age-related immune dysfunction, which may develop infections and malignancies and could be immunologically high risk due to the high rate of ABO-incompatibility and poor histocompatibility. An effort to minimize the adverse effect of immunosuppression and to reduce the risk of acute rejection may be needed for an excellent long-term outcome.

Keywords:
Kidney transplantation, Elderly, Spousal donors, Clinical outcome
1.
Danovitch G, Savransky E: Challenges in the counseling and management of older kidney transplant candidates. Am J Kidney Dis 2006;47:S86-S97.
2.
Oniscu GC, Brown H, Forsythe JL: How old is old for transplantation? Am J Transplant 2004;4:2067-2074.
3.
Smits JM, Persijn GG, van Houwelingen HC, Claas FH, Frei U: Evaluation of the Eurotransplant senior program. The results of the first year. Am J Transplant 2002;2:664-670.
4.
The Japanese Society for Clinical Renal Transplantation: Annual progress report from the Japanese renal transplant registry: number of renal transplantation in 2009, part 2. Jpn J Transplant 2010;45:595-607.
5.
Cooper M, Forland CL: The elderly as recipients of living donor kidneys, how old is too old? Curr Opin Organ Transplant 2011;16:250-255.
6.
Saxena R, Yu X, Giraldo M, Arenas J, Vazquez M, Lu CY, Vaziri ND, Silva FG, Zhou XJ: Renal transplantation in the elderly. Int Urol Nephrol 2009;41:195-210.
7.
Friedman AL, Goker O, Kalish MA, Basadonna GP, Kliger AS, Bia MJ, Lorber MI: Renal transplant recipients over aged 60 have diminished immune activity and a low risk of rejection. Int Urol Nephrol 2004;36:451-456.
8.
Uchida J, Machida Y, Iwai T, Kuwabara N, Iguchi T, Naganuma T, Kumada N, Kawashima H, Nakatani T: Clinical outcome of ABO-incompatible living unrelated donor kidney transplantation. Urol Int 2011;86:307-314.
9.
Uchida J, Iwai T, Kato M, Machida Y, Naganuma T, Kumada N, Yoshimura R, Kawashima H, Kim T, Nakatani T: A novel approach to successful ABO-incompatible high-titer renal transplantation. Transplant Proc 2008;40:2285-2288.
10.
Uchida J, Machida Y, Iwai T, Naganuma T, Kitamoto K, Iguchi T, Maeda S, Kamada Y, Kuwabara N, Kim T, Nakatani T: Desensitization protocol in highly HLA-sensitized and ABO-incompatible high titer kidney transplantation. Transplant Proc 2010;42:3998-4002.
11.
Uchida J, Iwai T, Machida Y, Kuwabara N, Kabei K, Murao M, Otoshi T, Naganuma T, Kumada N, Nakatani T: ABO-incompatible kidney transplantation in elderly patients over 60 years of age. Int Urol Nephrol 2012;44:1563-1570.
12.
Uchida J, Kuwabara N, Machida Y, Iwai T, Naganuma T, Kumada N, Nakatani T: Excellent outcomes of ABO-incompatible kidney transplantation: a single-center experience. Transplant Proc 2012;44:204-209.
13.
Kabei K, Uchida J, Iwai T, Yamasaki T, Kuwabara N, Naganuma T, Kumada N, Nakatani T: Late-onset neutropenia and acute rejection in ABO-incompatible kidney transplant recipients receiving rituximab and mycophenolate mofetil. Transpl Immunol 2014;31:92-97.
14.
Martins PN, Pratschke J, Pascher A, Fritsche L, Frei U, Neuhaus P, Tullius SG: Age and immune response in organ transplantation. Transplantation 2005;79:127-132.
15.
The Japanese Society for Clinical Renal Transplantation: Annual progress report from the Japanese renal transplant registry: number of renal transplantation in 2009. Jpn J Transplant 2010;48:608-620.
16.
Kasiske BL, Chakkera HA, Louis TA, Ma JZ: A meta-analysis of immunosuppression withdrawal trials in renal transplantation. J Am Soc Nephrol 2000;11:1910-1917.
17.
Friedersdorff F, Roller C, Manus P, Cash H, Stier K, Schmidt D, Budde K, Kemkensteffen C, Busch J, Fuller TF, Giessing M: Fate of finally transplanted deceased donor kidneys initially rejected at other kidney transplantation centers. Urol Int 2014;93:474-481.
18.
Friedersdorff F, Fuller TF, Werthemann P, Cash H: Outcome of single pediatric deceased donor renal transplantation to adult kidney transplant recipients. Urol Int 2014;92:323-327.
19.
Meier-Kriesche HU, Srinivas TR, Kaplan B: Interaction between acute rejection and recipient age on long-term renal allograft survival. Transplant Proc 2001;33:3425-3426.
20.
Zeng Y, Liu Z, Liu Y, Fan Y, Guo Y, Qiu J: Impact of HLA antibodies on graft survival in long-term renal recipients with functional grafts. Urol Int 2014;92:328-333.
21.
Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK: Renal transplantation in elderly patients older than 70 years of age: results from the scientific registry of transplant recipients. Transplantation 2007;83:1069-1074.
22.
Oniscu GC, Brown H, Forsythe JL: How great is the survival advantage of transplantation over dialysis in elderly patients? Nephrol Dial Transplant 2004;19:945-951.
23.
Gill J, Bunnapradist S, Danovitch GM, Gjertson D, Gill JS, Cecka M: Outcomes of kidney transplantation from older living donors to older recipients. Am J Kidney Dis 2008;52:541-552.
24.
Meier-Kriesche HU, Ojo AO, Hanson JA, Kaplan B: Exponentially increased risk of infectious death in older renal transplant recipients. Kidney Int 2001;59:1539-1543.
25.
US Department of Health and Human Services. KO13169; Cylex Immune Cell Function Assay, April 2, 2002.
26.
Khater N, Khauli R: Pseudorejection and true rejection after kidney transplantation: classification and clinical significance. Urol Int 2013;90:373-380.
27.
Yancik R, Ries LA: Aging and cancer in America. Demographic and epidemiologic perspectives. Hematol Oncol Clin North Am 2000;14:17-23.
28.
Kasiske BL, Snyder JJ, Gilbertson DT, Wang C: Cancer after kidney transplantation in the United States. Am J Transplant 2004;4:905-913.
29.
Guba M, von Breitenbuch P, Steinbauer M, Koehl G, Flegel S, Hornung M, Bruns CJ, Zuelke C, Farkas S, Anthuber M, Jauch KW, Geissler EK: Rapamycin inhibits primary and metastatic tumor growth by antiangiogenesis: involvement of vascular endothelial growth factor. Nat Med 2002;8:128-135.
30.
Wong G, Chapman JR: Cancers after renal transplantation. Transplant Rev (Orlando) 2008;22:141-149.
31.
Cibrik D, Silva HT Jr, Vathsala A, Lackova E, Cornu-Artis C, Walker RG, Wang Z, Zibari GB, Shihab F, Kim YS: Randomized trial of everolimus-facilitated calcineurin inhibitor minimization over 24 months in renal transplantation. Transplantation 2013;95:933-942.
32.
Uchida J, Machida Y, Iwai T, Kuwabara N, Kabei K, Naganuma T, Kumada N, Kawashima H, Nakatani T: Conversion of stable ABO-incompatible kidney transplant recipients from mycophenolate mofetil with standard exposure calcineurin inhibitors (CNIs) to everolimus with very low exposure CNIs-a short-term pilot study. Clin Transplant 2014;28:80-87.
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2015
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