Do Elderly Patients Deserve a Kidney Graft?

Abstract

Purpose. Compare renal transplant long-term outcomes among recipients aged 60 years or older with those in younger patients. Patients and methods. We analyzed 103 transplants in recipients above 60 years of age for the influence of key factors related to the graft and patient. The results were compared with 1060 transplant recipients aged 18 to 59 years. Results. The mean ages were 62.93 and 40.35 years for the older and younger group. The older group showed a higher prevalence of obesity and unknown etiologies for the end-stage renal disease. Important comorbidity was significantly more frequent among recipients aged more than 60 years, mainly of a cardiovascular nature (56% vs 18.5%). Donor age (39.75 vs 31.59 years), cold ischemia time (22.43 vs 20.49 hours) and human leukocyte antigen compatibilities (2.59 vs 2.36) were significantly greater in the older subset. After a mean follow-up of 4.72 and 6.07 years for the older versus younger group, we found no differences in initial graft function, acute rejection rate, and serum creatinine/clearance. Patient and graft survivals at 1, 5, and 10 years were lower among the 60ϩ group. There were no differences in graft survival censored for death with a functioning graft, namely, 95.1%, 89.4%, and 81.2% for the 60ϩ cohort. The main cause of graft loss in the older group was death with a functioning graft. Conclusion. Renal transplantation should be considered for selected patients older than 60 years. Despite a shorter life expectancy, they benefit from it similar to younger recipients. T HE INCIDENCE OF end-stage renal disease (ESRD)increases with advancing age. Patients older than 60 years represent between 53% and 66% of the population requiring renal replacement therapies.1 Therapy for ESRD in the elderly is characterized by tremendous challenges, raising medical, ethical, and socioeconomic concerns. Hemodialysis, the most frequently used renal replacement modality in these patients, is associated with significant morbidity, mortality, and a poor quality of life.2,3 The great organ shortage, higher comorbidity rate, and shorter life expectancy make the allocation of kidneys to this population controversial.Nevertheless, transplantation is the gold standard treatment for ESRD patients. With immunosuppression based upon calcineurin inhibitors, it has become a feasible alternative for the elderly population. 4 -7 Compared with hemodialysis, renal transplantation is associated with a 61% decrease in the long-term risk of death and an additional 4-year life expectancy for patients over 60 years. 4 In this retrospective study, we report a single-center, long-term follow-up of kidney transplants in patients above

Rabbit antithymocyte induction and dosing in deceased donor renal transplant recipients over 60 yr of age

“…The majority of these patients (∼90%) were maintained on commonly used modern immunosuppressive therapies including tacrolimus, mycophenolate mofetil, or sirolimus. Our findings are similar to previous reports, in which patients over the age of 60 exhibited a similar renal function and death‐censored graft survival compared to younger adult patients (4, 8). We observed a significantly lower rate of DGF in the >60 patients which occurred despite the increased use of ECD kidneys among this age group.…”

“…Several studies have reported lower mortality rates and improved quality of life in renal transplant patients with advanced age compared to those who remain on dialysis (2,3). In addition, short-term outcomes in older recipients are comparable to those in younger patients (4)(5)(6)(7)(8). Thus, kidney transplantation remains the treatment modality of choice in patients with end-stage renal disease (ESRD), regardless of age.…”

Outcomes of Renal Transplantation in Older High Risk Recipients: Is There an Age Effect?

“…Other studies have also failed to demonstrate statistically significant differences in the incidence of acute rejection between younger and older recipients both in Europe [10][11][12] and in the United States [6,13]. Nonetheless, other authors have reported that elderly patients may have a lower risk of acute rejection compared with younger recipients [14,15], a phenomenon supported by some data suggesting that metabolism of immunosuppressive medications may be altered with increased age [16].…”

Influence of recipient age on deceased donor kidney transplant outcomes in the expanded criteria donor era

“…Among the treatment modalities that are available for patients with ESRD, KT is preferred because it is associated with an improved life expectancy, better quality of life, and is cost-effective both for patients and for payers (1-4, 7-15, 18-25, 31-42). However, with the increasing disparity between the steadily rising number of potential transplant candidates and relatively static number of available organs, ethical concerns have been expressed that providing elderly patients with ESRD with scarce DD kidneys may result in significant limitations imposed on the useful life of donor organs (3,4,(20)(21)(22)(23)(24)(25)(37)(38)(39)(40)(41). However, a number of studies have demonstrated that KT offers both a cost and survival benefit to virtually all patients with ESRD regardless of age (3,4,7,8,(18)(19)(20)(21)(22)(23)(24)(25)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42).…”