Kidney and liver transplantation in the elderly

Abstract

Background: Transplant surgery is facing a shortage of deceased donor organs. In response, the criteria for organ donation have been extended, and an increasing number of organs from older donors are being used. For recipients, the benefits of transplantation are great, and the growing ageing population has led to increasing numbers of elderly patients being accepted for transplantation. Methods:The literature was reviewed to investigate the impact of age of donors and recipients in abdominal organ transplantation, and to highlight aspects of the fine balance in donor and recipient selection and screening, as well as allocation policies fair to young and old alike.Results: Overall, kidney and liver transplantation from older deceased donors have good outcomes, but are not as good as those from younger donors. Careful donor selection based on risk indices, and potentially biomarkers, special allocation schemes to match elderly donors with elderly recipients, and vigorous recipient selection, allows good outcomes with increasing age of both donors and recipients. The results of live kidney donation have been excellent for donor and recipient, and there is a trend towards inclusion of older donors. Future strategies, including personalized immunosuppression for older recipients as well as machine preservation and reconditioning of donor organs, are promising ways to improve the outcome of transplantation between older donors and older recipients.Conclusion: Kidney and liver transplantation in the elderly is a clinical reality. Outcomes are good, but can be optimized by using strategies that modify donor risk factors and recipient co-morbidities, and personalized approaches to organ allocation and immunosuppression.

Are Octogenarians With End-Stage Renal Disease Candidates for Renal Transplantation?

“…Time on dialysis before transplantation has been identified as a risk factor for posttransplant survival in elderly patients. 13,15 Compared with other transplant centers, the recipients in our study had a relatively short time on dialysis before transplantation, and the mean cold ischemia time was generally short. 16,17 …”

“…Although there has been an increase in living donation in some countries, both patients and their caretakers unfortunately often remain reluctant toward elderly spousal donations, paired kidney exchange, and the principle of “transplanting one generation up.” Knowing the importance of preemptive transplantation/reduced waiting time, specifically in the elderly, it was surprising to find that no octogenarian received a kidney from a living donor. 9,13 With an increasing number of octogenarians entering renal replacement therapy and being evaluated for transplantation, this will need to change. Use of living donors would also, most likely, improve the posttransplant outcome.…”

Liver transplantation in elderly patients: a systematic review and first meta-analysis

“…2,3 Therefore, surgeons are performing surgical procedures on an increasing number of elderly patients, 4 including organ transplantations. 5,6 The demand for grafts for the elderly is increasing in the field of liver transplantation (LT); based on data from the United Network for Organ Sharing (UNOS), the proportion of registrants and recipients aged 65 or 70 years doubled from 8.1% to 17% and from 1.4% to 3.1% between 2002 and 2014, respectively. 7 The same trend is present in the European Liver Transplant Registry; between 2000 and 2015, the proportion of recipients aged 65 or 70 years increased from 5% to 13% and from 0.3% to 1.3%, respectively (European Liver Transplant Registry, http://www.eltr.org accessed on March 13, 2017).…”

Elderly Donors in Transplantation

“…The use of a living donor is favored when possible, as living donor kidney transplantation (LDKT) has superior outcomes in comparison to DDKT [36][37][38]. LDKT can also significantly decrease time on the waiting list and eliminate or minimize time on dialysis, which is particularly important for elderly recipients [39].…”