NEW YORK (Reuters Health) - Excellent long-term outcomes can be achieved using kidney transplants from donors older than 60 years of age, provided that the grafts are histologically evaluated prior to implantation, according to a report in The New England Journal of Medicine for January 26.

In general, grafts from older donors do not survive as long as those from younger donors, Dr. Piero Ruggenenti, from the Mario Negri Institute for Pharmacological Research in Bergamo, Italy, and colleagues note. Selection of grafts from older donors based on preimplantation histologic characteristics might help narrow the gap in outcomes and expand the donor-organ pool, they add.

To investigate, the researchers compared the outcomes of 62 patients given histologically evaluated kidneys from an older donor with those of 248 matched recipients given non-evaluated kidneys from either older or younger donors. All of the recipients were older than 50 years of age.

Histologic evaluation scored the grafts for changes in glomeruli, vessels, tubules and connective tissues, for a global rating of 0-12. Kidneys with a score of 0-3 were used in single transplants, those scoring 4-6 were earmarked for dual transplants, and those rated 7 or worse were discarded.

During a median follow-up period of 23 months, the rate of progression to dialysis was 6% in the group given evaluated grafts from older donors, 7% among recipients of kidneys from younger donors, and 23% among recipients of non-evaluated kidneys from older donors. Using an evaluated graft from an older donor, rather than a non-evaluated one, cut the risk of graft failure by 3.68-fold.

In both the overall and older donor group analysis, preimplantation histologic assessment of grafts was associated with significantly improved survival, the report indicates.

Dr. Francis L. Delmonico and Dr. James F. Burdick, the heads of major transplantation organizations in the US, comment in a related editorial: "This Italian group reports results that are relevant to increasing the rate of successful kidney transplantation anywhere in the world."

N Engl J Med 2006;354:343-352,411-413

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