How does age affect the outcome of kidney transplantation in elderly recipients?

Abstract

The aging of the on-dialysis population raises the issue of whether to propose elderly patients for kidney transplantation and how to manage their immunosuppression. This study aimed to analyze the outcome of kidney transplantation on an Italian series of elderly recipients. We included in this retrospective study all patients over 60 years, receiving a deceased-donor kidney transplantation from January 2004 to December 2014 in two north Italian Centers. We analyzed the correlation of recipient age with graft's and patient's survival, delayed graft function, acute cellular rejection (ACR), surgical complications, infections, and glomerular filtration rate. Four hundred and fifty-two patients with a median age of 65 years were included in the study. One-, 3-, and 5-year patient's and graft's survival were, respectively, of 98.7%, 93%, 89% and 94.4%, 87.9%, 81.4%. The increasing recipient age was an independent risk factor only for the patient's (P=.008) and graft's survival (P=.002). ACR and neoplasia were also associated to a worse graft survival. The reduced graft survival in elderly kidney recipients seems to be related more to the increasing recipient's age than to the donor's features. In this population, the optimization of organ allocation and immunosuppression may be the key factors to endorse improvements.

Improved outcomes after live donor renal transplantation for septuagenarians

“…Although death censored graft survival is equivalent, elderly patients have shorter life expectancies imposing challenges when justifying the use of a live donor kidney. Previous research has reported the mortality benefits of renal transplantation are experienced around 3 months post‐transplant and financial benefits are accrued 2 years post operation . Our data from the fourth era (2013‐2016) reported the younger generation had a 95% graft and 98% patient survival rate 2 years post transplantation while the septuagenarians had 93% graft and 94% patient survival, respectively.…”

“…Compared to dialysis, it is associated with improved quality of life as well as cost‐effectiveness . Elderly recipients generally experience a lower risk of rejection and equivalent death censored graft survival . Even extended criteria donor (high KDPI) kidneys are known to deliver improved outcomes for those aged greater than 65 …”

Single-center analysis of infectious complications in older adults during the first year after kidney transplantation

“…While it is known that older adults have lower rejection rates after transplant[7,18,15] our rate (8%) is extremely low. Other groups have described rejection rates ranging from 11%−25% in patients with varying ages over 60[9,10,15,18,19]. The paradox of higher infection and lower rejection rates in the aged KT population calls to question whether the older cohort is over-immunosuppressed, a consequence of too much exogenous immunosuppression and immunosenescence.…”

“…Additionally, their clinical presentation is often atypical, making diagnosis challenging. Information in the literature mainly comprises traditional outcomes such as rejection, patient and graft survival[7,8]; information regarding infection specifics is limited[1,9,10]. …”

Post-transplant Viral Respiratory Infections in the Older Patient: Epidemiology, Diagnosis, and Management

“…During the 1980s, the number of people between the ages of 75 and 79 increased by 28.8%, and those over the age of 85 years increased by 52.4% [1]. Not only has the life expectancy in older individuals increased, but their general health has also improved [1,2].…”