Successful outcomes of older donors in laparoscopic donor nephrectomy.

BACKGROUND AND PURPOSE: Healthy older living donors (> 50 years) are helping meet increasing demands for kidney transplantation. Live donor grafts perform better than cadaveric donor grafts; however, concern surrounds the expected nephron loss of the donors as well as the relative safety to the donor. We examined the effect age had on living laparoscopic donor and recipient outcomes at a single institution. PATIENTS AND METHODS: We retrospectively reviewed records of 101 patients who underwent laparoscopic donor nephrectomy (LDN) from October 2001 to December 2005. Twenty-nine (29%) who were aged 50 years or older, denoted as the "older" group, were compared with the remaining 72 (71%) donors who were younger than 50 years and served as controls. Perioperative and follow-up data were analyzed for both groups. RESULTS: The mean age at the time of donation was 36.1 and 54.3 years for control and older donors, respectively (P < 0.001). Baseline mean creatinine level was 0.82 mg/dL for controls and 0.84 mg/dL for older donors (P = 0.78). Complications in controls and the older group were 18% and 17%, respectively. One-year transplant survival was 100% for the controls and 96% for the older group. Average creatinine level at longer follow-up of 19 months for controls and 23 months for the older group (P = 0.34) was 1.22 mg/dL and 1.16 mg/dL, respectively (P = 0.535). CONCLUSION: LDN in donors older than 50 years of age appears safe and demonstrates similar outcomes compared with the control cohort of patients younger than 50 years. Age between 50 and 65 years should not exclude a potential donor who otherwise satisfies donor nephrectomy criteria.

Combination of BCG and interferon intravesical immunotherapy: an update.

OBJECTIVE: To provide an update on the use of interferon (IFN) in the treatment of non-muscle invasive bladder cancer (NMIBC). METHODS: A literature review of intravesical IFN was performed. RESULTS: In vitro evidence suggested that IFN combined with BCG may have a synergistic effect on the immune response, and treatment regimens with IFN have used reduced BCG dosage in an attempt to reduce toxicity. IFN combined with BCG may salvage some patients, single-course BCG failures or late relapsers, while those that relapse quickly may be destined to failure. However, based on the results of a recently reported randomized trial, the addition of IFN may not improve efficacy in BCG naïve patients. CONCLUSIONS: BCG plus IFN remains an alternative in selected patients with NMIBC who fail intravesical BCG.