[New scores in renal transplantation: How can we use them?]

[Very-old deceased donors in kidney transplantation: How far can we go?]

In order to increase the pool of organ donors, kidney transplantation from very old-donors, notably aged more than 70, is increasing. Compared to the United States, where the use of these grafts does not reach 5%, in France it reaches over 20%. Kidney aging is determined by a progressive glomerusclerosis, interstitial fibrosis, and nephrosclerosis, responsible of a linear decrease of glomerular filtration rate with time. Aging in kidney transplantation goes along also with an increased immunogenicity and risk of ischemia-reperfusion injuries. Hence, the prognosis of these transplantations is worse than those from younger donors, even though it remains better than dialysis. Data is lacking on risk factors of graft loss in this specific population. Hypothermic perfusion machine, pre-implantation kidney biopsy, dual kidney transplantation and immunosuppressive strategies have been evaluated to improve the long-term prognosis of these grafts.

Assessment of Major Posttransplant Complications Risk Among Potential Recipients of Kidney Transplant in Saint-Louis, Senegal

INTRODUCTION

Recipients of kidney transplants are a very heterogeneous population and the risk of posttransplantation complications markedly varies according to the recipient's status. Scoring systems that predict survival outcome after kidney transplantation can help physicians improve risk stratification among recipients and make the best therapeutic decisions. This study aimed to assess the 1-year risk of major adverse events in potential recipients of kidney transplant at Saint-Louis University Hospital.

MATERIAL AND METHODS

We performed a cross-sectional study including 65 patients with end-stage renal disease who were treated in the hemodialysis unit at Saint-Louis University Hospital. Scoring was based on a simple clinical tool with 4 items (age, cardiopulmonary factors, functional status, and metabolic parameters) reported to predict risk of severe adverse events during the first posttransplant year.

RESULTS

The mean age of patients in years ± SD was 46.9 ± 23.5 and 53% were male. Median dialysis duration was 29.9 months and the main causes of kidney disease were hypertension and diabetes. A history of coronary artery disease was present in 22.3% of patients, and 33.5% had a high cardiovascular risk. According to the clinical score, 63.8% of potential recipients of kidney transplant presented a high risk of adverse events and 12.5% had a low risk of developing major complications during their first year posttransplantation.

CONCLUSIONS

This study shows that based on a simple pretransplant clinical assessment, two-thirds of our patients are at high risk for major adverse events during their first posttransplantation year. Such information could be invaluable during the counseling of donor and recipient couples.