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Laparoendoscopic surgery including hand-assisted techniques has recently become a standard procedure for living donor nephrectomy, even in elderly patients, because of its advantages of less invasiveness and greater safety. However, grafts from elderly donors show impaired function compared with those from younger donors. We assessed whether kidneys procured from living donors over 70 years of age are feasible as the grafts for kidney transplant recipients.METHODS: Between July 2004 and December 2014, 204 living donors who underwent laparoscopic nephrectomy at our institution, with or without hand assistance, were enrolled in this study. Twenty-seven donors (13.2%) were 70 years of age or older (mean, 73.8 years; range, 70 to 80 years), and 177 were under 70 years (mean age, 55.8 years; range, 25 to 69 years). During the perioperative and postoperative periods, clinical parameters, including kidney function, as well as survival and function of the grafts, were evaluated in the transplant recipients.RESULTS: None of the donors developed major complications. Among patients receiving grafts from older donors, clinical parameters, including surgical outcome, and the incidence of surgical complications and delayed graft function did not differ from those in patients receiving grafts from younger donors. Through the follow up period, the postoperative mean level of serum creatinine in recipients receiving grafts from older donors was significantly higher than those from younger donors. The frequency of allograft losses in recipients receiving grafts from older donors was not significantly different from those from younger donors. However, graft function in recipients receiving grafts from older donors was significantly worse than those from younger donors and it gradually deteriorated at 4 or 5 years after kidney transplantation.CONCLUSIONS: Up to 10 years after kidney transplantation, graft survival in recipients receiving grafts from donors with 70 years of age or older was equivalent to those from younger donors. However, the gap in graft function between kidneys from older and younger donors gradually widened at several years after kidney transplantation.

permitted. OBFU at 3-5 months was recommended for all. The primary outcome was the rate of unplanned events by follow up method. Secondary outcomes included rate of patient satisfaction, crossover, and compliance with 3-5 month OBFU. Appropriate statistical analyses were performed with significance set at p<0.05.RESULTS: We included 237 patients enrolled from 5 sites (TBFU:121 vs. OBFU: 116). Average age was 56 years (Range: 34-87), and BMI was 26.3 (STD: 4.5). The majority of the sample was White (48%) or Asian (46%). No differences in demographics or medical comorbidities were noted between the study groups (p: 0.09-1.0). Comparing TBFU to OBFU, no differences were noted in unplanned events e hospital admission, emergency department visit, or unplanned office visit or call (14% vs. 12.9%, p[0.85) or adverse medical events (9.9% vs. 8.6%, p[0.82). TBFU and OBFU patients were equally "very satisfied" with their surgical outcomes (71.1% vs. 69%, p[0.2). Predictors of satisfaction included non-White ethnicity (p<0.01; OR: 3.2, 95% CI: 1.4-7.4) and no college-level education (p<0.01; OR: 7.4, 95% CI: 1.77-31). Sixteen (13.2%) TBFU patients requested crossover to OBFU; age > 65 was predictive of crossover (p[0.048; OR: 3.3, 95% CI: 1.1-9.9). TBFU patients were more compliant with 3-5 month OBFU (90.1% vs. 79.3%, p[0.04).CONCLUSIONS: After MUS placement, TBFU is a safe, feasible patient communication option in the early postop period. With TBFU patients report no difference in satisfaction compared to OBFU but had greater compliance with 3-5 month follow up. Older patients were more likely to cross over from TBFU to OBFU.

p>0.0001]) and if they had government insurance (OR[1.27, p[0.046).CONCLUSIONS: Predictors of orchiectomy vary for different age groups depending on time and day of presentation, insurance type, and presentation to a trauma center. These findings have implications for a healthcare systems approach to improving pediatric urological outcomes.