Organ shortage remains the major limitation to renal transplantation. Despite the rate of organ donation having increased to 18.4 donors/million inhabitants in northern Italy, the percentage of patients transplanted within 30 months of joining the waiting list is still only 40%. In recent years, there has also been a clear trend in the cadaveric donor pool for a shift in age distribution toward a larger percentage of older donors. The transplantation of kidneys from older donors has become a necessity with which all transplant centers must cope. Donor age significantly affects graft survival: a reduction of at least 10% has been shown using older donors.1 The reduction in nephron mass, and consequently in the functional reserve, of the older kidney makes it more susceptible to immunological assault, ischemic insult, and drug toxicity.
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