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Introduction. Chronic renal failure develops more often in elderly patients after previous repeated urological operations. Urological diseases are an important additional factor that multiply complicates kidney transplantation due to the need for preliminary correction of existing disorders. Not to mention the fact that the recipient's advanced age contributes to the risk of developing graft dysfunction due to the presence of concomitant diseases that worsen the immediate and long-term results of transplantation.Material and methods. We carried out the analysis of clinical observations and studies performed in 124 patients who underwent cadaveric renal allotransplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine, including from suboptimal donors. Of these, 69 (55.6%) recipients older than 60 years were included in the main group (group 1), and 55 recipients younger than 60 years (44.4%) – in the comparison group (group 2). From the patients of group 1, patients with urological diseases that led to the development of terminal chronic renal failure, or with previously undergone surgeries for urological diseases (subgroup 1A, 43 patients) were isolated. The remaining 26 patients who did not have urological diseases were put in subgroup 1B.Results. The analysis showed that in the early postoperative period in the recipients of group 1, complications developed in almost all the patients (80 complications in 64 of 69 patients, that is, 92.8% of patients in this group), whereas in group 2, complications developed only in 30.9% of patients (27 complications in 17 of 55 patients). At the same time, on average, 1.2 complications per 1 patient were noted in group 1, and 0.5 complications per 1 patient in group 2, a significant part of the complications occurred in the subgroup of patients with a burdened urological history (subgroup 1A). Late complications also developed statistically significantly more often (almost 2 times) in recipients with a burdened urological history.Conclusions. Complications of the early and late postoperative period develop statistically significantly more often in elderly recipients. The presence of a burdened urological history in elderly recipients significantly increases the risk of early and late postoperative complications.

Introduction. Among the growing number of patients with chronic renal failure who need dialysis therapy or kidney transplantation, a significant proportion are people over 60 years old, making from 30 to 45% of all patients who need dialysis, according to various sources. The elderly age of the recipient contributes to the risk of developing graft dysfunction due to the presence of concomitant diseases that worsen the immediate and long-term results of transplantation. And the probability of receiving a kidney graft in elderly patients is significantly lower than in young recipients. One of the ways to solve this problem is to use kidneys from suboptimal donors.Material and methods. The analysis of clinical examinations, laboratory and instrumental test results obtained in 124 patients who underwent cadaveric kidney allotransplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine, including that from suboptimal donors, was carried out. Of these, 69 (55.6%) recipients aged 60 years and older were included in the main group (group 1), and 55 recipients younger than 60 years (44.4%) in the comparison group (group 2).Results. Kidney transplantation to elderly patients (aged 60 years and older), including from a suboptimal donor, provides a sufficiently high efficiency with a 1-year recipient survival rate of 98.6% and a functioning graft for 1 year in 75.4% of cases, which does not differ from the survival rate of younger recipients (98.2%), but is inferior by the case rate of keeping the graft functioning (91.9%). Meanwhile, the parameters characterizing the functional state of the transplanted organs that maintained their function for 1 year did not differ statistically significantly between elderly and younger recipients.Conclusions. The results of the study showed that kidney transplantation from suboptimal donors to patients of the older age group provides acceptable results with low mortality of recipients and a 1-year functioning of the graft in 75% of cases. This makes it possible to increase the availability of kidney transplantation for patients of the older age group and achieve better survival results, provided adequate selection of recipients and an objective assessment of the quality of transplanted organs.

Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.

Introduction: The expansion of the criteria for donor organ retrieval contributes to an increase in the number of kidney transplantations to elderly recipients; but in view of reduced requirements to donor organ quality, a further analysis of transplantation outcomes is needed. The aim was to analyze and compare the outcomes of kidney transplantation to elderly patients depending on the donor organ quality.Material and methods. The study was based on the analysis of the kidney transplantation outcomes in 61 elderly recipients, including 51 transplantations performed from expanded criteria donors (group 1), and other 10 from standard donors (group 2). Based on clinical, laboratory, histological, and instrumental diagnostic data, we compared the graft function recovery rates, graft/recipient survival rates, the causes of graft loss in the early posttransplant period.Results: Patients of group I had significantly higher delayed graft function rates (37.3% vs. 10%), graft non-function rates (15.7% vs. 0%), and lower early posttransplant survival rates (72.5% vs. 100%). Graft function recovery rate was 58.8% in group I, and 100% in the patients of group II. The most common cause of the graft loss and the renal graft removals performed in the early posttransplant period was the poor graft quality due to the donor's existing pathology.Conclusion. The study demonstrated a statistically significant deterioration of the initial graft function, significantly increased graft non-function rates, and decreased graft survival rates in the early posttransplant period in the elderly recipients after kidney transplantation from expanded criteria donors.