Bora BARUT, Fatih GÖNÜLTAŞ, Sertaç USTA, Bülent ÜNAL, Turgut PİŞKİN, Üner KAYABAŞ

AKRABA YAŞLI CANLI DONÖRLERDEN YAPILAN BÖBREK NAKİLLERİ

AMAÇ: Son dönem böbrek hastalığının en iyi tedavi yöntemi böbrek nakli yapılmasıdır. Organ kısıtlılığı nedeni ile yaşlı donörlerin kullanımı giderek artmaktadır. Bizde Kasım 2010 ile Aralık 2013 tarihleri arsaında yaşı >= 60 olan canlı donörlerden 15 böbrek nakli yaptık. Bu çalışmamızda da bu 15 böbrek nakli ile ilgili deneyimlerimizi ve sonuçlarımızı paylaşmak istedik.GEREÇ VE YÖNTEMLER: Biz merkezimizde Kasım 2010 ile Aralık 2013 tarihleri arasında 98 böbrek nakli yaptık. Bunların 15'ini yaşı >= 60 olan canlı akraba donörlerden alıcılara naklettik. Bu 15 donör ve bunların alıcılarının verileri geriye doğru toparlanıp incelendi. BULGULAR: Donörlerin ve alıcılarını sırası ile yaş ortalamaları 64, 3 ve 40.1 idi. Alıcılar için ortalama takip süresi 18.8 aydı. Bu sürede graft sağkalımı %100'dü. Ancak bir alıcımız nakil sonrası dördüncü ayında intrakranial kanama nedeni ile foksiyone greftle kaybedildi. İnfeksiyon, teknik nedenler, tekrarlayan hastalık yada rejeksiyon nedeni ile börek kaybedilmedi. Donörlerimizde hayatlarını herhangi bir problem olmaksızın saglıklı bir şekilde sürdürmektedirler.SONUÇ: Yaşlı donörler ideal donörler değildir. Ancak alıcıların başka bir donörü yoksa yaşlı donörlerden nakil yapmak bu hastalar icin bir seçenek olmaktadır.

KIDNEY TRANSPLANTATION FROM LIVING RELATED ELDERLY DONORS

OBJECTIVE: Kidney transplantation is the best treatment method for end-stage renal disease. Because of organ shortage, living elderly donor usage is increasing day by day. We have performed 15 kidneys transplantation form living elderly donors (donor age >= 60 years) between November 2010 and December 2013. Here, we present our experiences and outcomes about these 15 marginal kidney transplantations.MATERIAL AND METHODS: We have performed 98 kidneys transplantation between November 2010 and December 2013. Fifteen of kidney transplantations were performed form living related elderly donors (donor age >= 60 years). These 15 donors and their recipients' datum were collected and retrospectively analyzed.RESULTS: The mean age of donors and recipients were 64,3 , 40.1 years, respectively. The mean flows up times were 18.8 months for recipients. Graft survival was 100% in this period, but one recipient with functional graft died from intracranial bleeding four months after transplantation. No kidney was lost from rejection, technical causes, infection or recurrent disease. The donors are living their lives without any problems.CONCLUSION: The elderly donors aren't ideal donors, but they are one of the options if their recipients don't have any other donors for kidney transplantation.

PDF

___

1)Basic-Jukic N, Furic-Cunko V, Kes P, et al: Outcome after renal transplantation in a "senior" program: the Croatian experience. Transplant Proc 2008; 40: 3418-21.
2)Unal B, Piskin T, Koz S, Ulutas O, Yilmaz M, Yilmaz S. En bloc and dual kidney transplantation: two initial cases from a new kidney transplantation center. Transplant Proc 2012; 44: 1700-2.
3)Solá R, Guirado L, López-Navidad A, et al: Is it appropriate to implant kidneys from elderly donors in young recipients? Transplantation 2010; 90: 286-91.
4)Giessing M, Slowinski T, Deger S, et al: 20-year experience with elderly donors in living renal transplantation. Transplant Proc 2003; 5: 2855-7.
5)Sahin S, Manga Sahin G, Turkmen A, Sever MS. Utilization of elderly donors in living related kidney transplantation. Transplant Proc 2006; 38:385-7.
6)Piskin T, Unal B, Koz S, et al: A kidney transplant center's initial experiences in eastern Turkey. Transplant Proc 2012; 44: 1685-9.
7)Sözen H, Fidan K, Onaran M, Arinsoy T, Dalgiç A. Outcome of the using older donors for kidney transplantation;Gazi University, Ankara experience. Transplant Proc 2010; 42: 2477-8.
8)Mzoughi S, Albano L, Criste M, et al: Two-year results of renal transplantation in kidney recipients from > or = 65-year-old deceased donors: a French region experience. Transplant Proc 2007; 39: 2576-7.
9)Vistoli F, Boggi U, Vanadia Bartolo T, et al: Kidney transplantation from donors aged more than 65 years. Transplant Proc 2004; 36: 481-4.
10)Végsö G, Máthé Z, Péter A, Perner F, Járay J, Langer RM. Improving results of renal transplantation with the use of elderly donors: the Budapest experience. Transplant Proc 2005; 37: 4225-7.
11)Bilgin N, Karakayali H, Moray G, et al: Outcome of renal transplantation from elderly donors. Transplant Proc 1998; 30: 744-6.
12)Minnee RC, Bemelman WA, Polle SW, et al: Older living kidney donors: surgical outcome and quality of life. Transplantation 2008; 86: 251-6.
13)Serur D, Charlton M. Expanded criteria living donors: how far can we go? Prog Transplant.; 2012; 22: 129-32.
14)Solá R, Guirado L, Díaz JM, López-Navidad A, Caballero F, Gich I. Elderly donor kidney grafts into young recipients: results at 5 years. Transplantation 2002; 73: 1673-5.
15)Singh AK, Sharma RK, Agrawal S, et al: Long-term allograft survival in renal transplantation from elderly donors. Transplant Proc 1998; 30: 3659.
16)Rigotti P, Baldan N, Valente M, et al: Evaluation of 84 elderly donors in renal transplantation. Clin Transplant 2004; 18: 440-5.
17)Delmonico F; Council of the Transplantation Society. A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines. Transplantation 2005; 79: S53-66.
18)Tasaki M, Saito K, Nakagawa Y et al. Effect of donor-recipient age difference on long-term graft survival in living kidney transplantation. Int Urol Nephrol 2014; 46: 1441-6.
19)Lim WH, Clayton P, Wong G, et al: Outcomes of kidney transplantation from older living donors. Transplantation 2013; 95: 106-13
20)Toyoda M, Yamanaga S, Kawabata C, et al. Long-term safety of living kidney donors aged 60 and older. Transplant Proc. 2014; 46: 318-20