The altruistic elderly, a valuable but unrecognised kidney donor group. A case report of an 85-year-old unspecified kidney donor.

BACKGROUND: Kidney transplantation is the definitive treatment for end stage renal disease (ESRD), offering improved quality of life and survival benefit over remaining on dialysis. There is, however, a prevailing significant mismatch between patients awaiting transplantation and available donor kidneys. Over time, initial stringent donor criteria have broadened and organs from extended criteria donors (ECDs) and older donors are now being accepted for transplantation. The spectrum of living donors has also undergone a change from close family members to an increasingly non-related, non-directed altruistic donors, newly classified as 'unspecified' donors. Unspecified elderly donors could be a potential untapped resource to expanding the kidney donor pool globally. CASE PRESENTATION: We present a case of an 85 year and 8 months old individual, who donated to an unrelated non-directed matched recipient in the national deceased donor transplant waiting list with excellent donor and recipient outcomes at 7 years. CONCLUSION: To our knowledge she is one of the oldest reported unspecified living kidney donors in the world to date. This case illustrates that elderly donors in good health can come forward to donate, knowing that it is safe and valuable. Once the immediate perioperative challenges after kidney donation are managed, elderly donors rarely encounter long term sequelae. We therefore report this case to increase awareness and refocus attention of transplant teams on elderly donors as a potential untapped group to help address the organ shortage problem in renal transplantation.

Kidney Transplant Recipients Requiring Critical Care Admission Within One Year of Transplant.

OBJECTIVES: Kidney transplant is the gold standard for treatment of renal failure. With the increasing age of the recipient population, which carries significant comorbidities, and the use of more marginal organs, there is potential for increased critical care admissions. In this study, we investigated the incidence, indications, and outcomes of patients admitted to critical care within 1 year of transplant. We also aimed to identify any precipitating factors or events that may trigger these admissions, as well as establish variables that could affect mortality. MATERIALS AND METHODS: We performed a retrospective analysis of kidney transplant recipients admitted to critical care within 1 year after transplant, between January 2009 and December 2013. RESULTS: Of 1002 kidney transplants, 53 patients (5.3%) were admitted to critical care within 1 year, with patients separated into 2 groups. Group 1 comprised 32 patients (61%) who were admitted immediately postoperatively, mainly from cardiorespiratory derangements with mean stay of 3.7 days (range, 1-34 days) and 0 mortalities. Group 2 comprised 21 patients (39%) who were admitted later in the postoperative period, principally from sepsis-related complications with a mean stay of 18 days (range, 1-101 days). Most patients in group 2 required intensive therapy, including mechanical ventilation and immunosupprression reduction, incurring a hospital mortality rate of 48%. Hemorrhage with reexploration was higher in group 1. Diabetes mellitus, cardiac comorbidity, prolonged stay, nutritional support, nosocomial infections, and multiple organ failure were found at a higher rate in the group 2 patients who died. CONCLUSIONS: The incidence of critical care admissions 1 year after kidney transplant was 5.3%. Most admissions occurred in the early postoperative period, mostly as preemptive measures for cardiorespiratory monitoring and support. This category of admission is potentially preventable with optimization of preoperative treatment. Later admissions were mostly consequential to sepsis-related complications, with patients having a high mortality rate due to multiple organ failure. Clinical management should therefore focus on the prevention of multiple organ failure to improve patient outcomes.