Long-term safety of living kidney donors aged 60 and older.

In Japan, kidney transplantation procedures are usually dependent upon live donors. As the recipient ages have been increasing, so has there been a corollary increase in the age of the live donors. Despite this being controversial, the use of older donors is becoming increasingly common. The purpose of our study was to evaluate the long-term safety of accepting older living kidney donors and graft survival rates. We retrospectively analyzed long-term donor outcomes for consecutive patients at our institution between January 1990 and December 2011. Older live kidney donors were defined as ≥ 60 years and younger live kidney donors were defined as <60 years old. Thirty-three were ≥ 60 years and 55 donors were <60 years. The mean follow-up term was 7 years and 4 months. Predonation, older donors had a lower estimated glomerular filtration rate (eGFR) level (77.1 ± 9.5 mL/min/1.73 m(2)) than younger donors (85.8 ± 14.6 mL/min/1.73 m(2); P < .01). More older donors had a history of hypertension (42.4% vs 9.1%; P < .01). In both groups, eGFR levels decreased about 40% immediately after nephrectomy. Residual renal function though was stable on long-term follow-up. The incidence of de novo hypertension and proteinuria after nephrectomy was not different between the 2 groups. In older donors, there were no perioperative complications that required extended hospital stays. Graft survival over a period of 10 years was similar in both groups. In our study, donor age had no influence on the deterioration of renal function after nephrectomy. Regardless of age, careful evaluation and follow-up are important for the donor's long-term safety after donation.

[A case of acute cibenzoline intoxication in a hemodialysis patient].

After taking cibenzoline (200 mg/day, p.o.) for 6 days, a 72-year-old man, who had been on hemodialysis for one year, complained of general fatigue, chest oppression and muscular weakness. These symptoms got worse after taking another tablet of cibenzoline on admission. We strongly suspected cibenzoline intoxication and stopped cibenzoline p.o. immediately. On the next early morning, he became comatose and QRS interval was markedly prolonged on the electrocardiogram. The plasma cibenzoline level was 3,248 ng/ml. After endotracheal intubation, the respiration was supported with a ventilator. We also started hemodiafiltration and his consciousness became clearer with the QRS interval shortening. He was weaned from the respirator 8 hours after hemodiafiltration started. Finally the concentration of plasma cibenzoline normalized to 210 ng/ml after 4 times hemodialysis. Because cibenzoline is mainly excreted by kidney, the plasma cibenzoline level should be followed carefully, when it is administered in patients with renal dysfunction.