Kidney Transplantation in Septuagenarians: 70 Is the New 60!

Hebert, Sean A.; Ibrahim, Hassan N.

doi:10.1016/j.ekir.2019.03.015

Cited by 5 publications

(8 citation statements)

References 8 publications

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“…Given the scarcity of robust evidence to underpin the anticipated survival advantage for kidney transplant recipients, it remains unclear whether kidney transplant improves survival for patients eligible for transplant of all ages and whether the duration of pretransplant dialysis reduces anticipated survival benefits for transplant recipients compared with their peers remaining on a wait list while receiving long-term dialysis. 8 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

“…7 Given the scarcity of robust evidence to underpin the anticipated survival advantage for kidney transplant recipients, it remains unclear whether kidney transplant improves survival for patients eligible for transplant of all ages and whether the duration of pretransplant dialysis reduces anticipated survival benefits for transplant recipients compared with their peers remaining on a wait list while receiving long-term dialysis. [8][9][10] Our hypotheses were that survival benefits achieved with kidney transplant diminish with increasing recipient age and as waiting time with maintenance dialysis lengthens owing to an increasing frailty of the patient population. The primary aim of our study therefore was to investigate survival benefit between kidney transplant and long-term dialysis for transplant-eligible patients across different candidate ages.…”

Section: Introductionmentioning

confidence: 99%

“…JAMA Network Open. 2022;5(10):e2234971. doi:10.1001/jamanetworkopen.2022.34971 (Reprinted) October 7, 2022 9/12 Downloaded From: https://jamanetwork.com/ on 10/16/2022…”

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confidence: 99%

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Survival Benefit of First Single-Organ Deceased Donor Kidney Transplantation Compared With Long-term Dialysis Across Ages in Transplant-Eligible Patients With Kidney Failure

et al. 2022

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ImportanceKidney transplant is considered beneficial in terms of survival compared with continued dialysis for patients with kidney failure. However, randomized clinical trials are infeasible, and available evidence from cohort studies is at high risk of bias.ObjectiveTo compare restricted mean survival times (RMSTs) between patients who underwent transplant and patients continuing dialysis across transplant candidate ages and depending on waiting time, applying target trial emulation methods.Design, Setting, and ParticipantsIn this retrospective cohort study, patients aged 18 years or older appearing on the wait list for their first single-organ deceased donor kidney transplant between January 1, 2000, and December 31, 2018, in Austria were evaluated. Available data were obtained from the Austrian Dialysis and Transplant Registry and Eurotransplant and included repeated updates on wait-listing status and relevant covariates. Data were analyzed between August 1, 2019, and December 23, 2021.ExposuresA target trial was emulated in which patients were randomized to either receive the transplant immediately (treatment group) or to continue dialysis and never receive a transplant (control group) at each time an organ became available.Main Outcomes and MeasuresThe primary outcome was time from transplant allocation to death. Effect sizes in terms of RMSTs were obtained using a sequential Cox approach.ResultsAmong the 4445 included patients (2974 men [66.9%]; mean [SD] age, 52.2 [13.2] years), transplant was associated with increased survival time across all considered ages compared with continuing dialysis and remaining on the wait list within a 10-year follow-up. The estimated RMST differences were 0.57 years (95% CI, –0.14 to 1.84 years) at age 20 years, 3.01 years (95% CI, 2.50 to 3.54 years) at age 60 years, and 2.48 years (95% CI, 1.88 to 3.04 years) at age 70 years. The survival benefit for patients who underwent transplant across ages was independent of waiting time.Conclusions and RelevanceThe findings of this study suggest that kidney transplant prolongs the survival time of persons with kidney failure across all candidate ages and waiting times.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival Benefit of First Single-Organ Deceased Donor Kidney Transplantation Compared With Long-term Dialysis Across Ages in Transplant-Eligible Patients With Kidney Failure

et al. 2022

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“…There is no consensus on a maximum age for transplanting CKD patients, but physiological age seems to be a better predictor of post-KT results and not chronological age [ 13 ]. Advanced chronological age alone should not prevent a patient from accessing KT, as current evidence suggests favourable elderly outcomes for both septuagenarians [ 14 ] and octogenarians [ 15 , 16 ]. Therefore, after carefully considering the risks and benefits of KT, elderly people with CKD should continue to be considered for KT, with individualization on a case-by-case basis, rather than generalizations about therapeutic options based only on chronology [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…ere is no consensus on a maximum age for transplanting CKD patients, but physiological age seems to be a better predictor of post-KTresults and not chronological age [13]. Advanced chronological age alone should not prevent a patient from accessing KT, as current evidence suggests favourable elderly outcomes for both septuagenarians [14] and octogenarians [15,16].…”

Section: Introductionmentioning

confidence: 99%

Logistic Regression Model in a Machine Learning Application to Predict Elderly Kidney Transplant Recipients with Worse Renal Function One Year after Kidney Transplant: Elderly KTbot

Júnior

Couto²,

Pereira

et al. 2020

Journal of Aging Research

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Background. Renal replacement therapy (RRT) is a public health problem worldwide. Kidney transplantation (KT) is the best treatment for elderly patients’ longevity and quality of life. Objectives. The primary endpoint was to compare elderly versus younger KT recipients by analyzing the risk covariables involved in worsening renal function, proteinuria, graft loss, and death one year after KT. The secondary endpoint was to create a robot based on logistic regression capable of predicting the likelihood that elderly recipients will develop worse renal function one year after KT. Method. Unicentric retrospective analysis of a cohort was performed with individuals aged ≥60 and <60 years old. We analysed medical records of KT recipients from January to December 2017, with a follow-up time of one year after KT. We used multivariable logistic regression to estimate odds ratios for elderly vs younger recipients, controlled for demographic, clinical, laboratory, data pre- and post-KT, and death. Results. 18 elderly and 100 younger KT recipients were included. Pretransplant immune variables were similar between two groups. No significant differences (P>0.05) between groups were observed after KT on laboratory data means and for the prevalences of diabetes mellitus, hypertension, acute rejection, cytomegalovirus, polyomavirus, and urinary infections. One year after KT, the creatinine clearance was higher (P = 0.006) in youngers (70.9 ± 25.2 mL/min/1.73 m2) versus elderlies (53.3 ± 21.1 mL/min/1.73 m2). There was no difference in death outcome comparison. Multivariable analysis among covariables predisposing chronic kidney disease epidemiology collaboration (CKD-EPI) equation <60 mL/min/1.73 m2 presented a statistical significance for age ≥60 years (P = 0.01) and reduction in serum haemoglobin (P = 0.03). The model presented goodness-fit in the evaluation of artificial intelligence metrics (precision: 90%; sensitivity: 71%; and F1 score: 0.79). Conclusion. Renal function in elderly KT recipients was lower than in younger KT recipients. However, patients aged ≥60 years maintained enough renal function to remain off dialysis. Moreover, a learning machine application built a robot (Elderly KTbot) to predict in the elderly populations the likelihood of worse renal function one year after KT.

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A Comprehensive Review of Infections in Older Kidney Transplant Recipients

Abidi

Erlandson

2021

Curr Transpl Rep

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Kidney Transplantation in Septuagenarians: 70 Is the New 60!

Cited by 5 publications

References 8 publications

Survival Benefit of First Single-Organ Deceased Donor Kidney Transplantation Compared With Long-term Dialysis Across Ages in Transplant-Eligible Patients With Kidney Failure

Survival Benefit of First Single-Organ Deceased Donor Kidney Transplantation Compared With Long-term Dialysis Across Ages in Transplant-Eligible Patients With Kidney Failure

Logistic Regression Model in a Machine Learning Application to Predict Elderly Kidney Transplant Recipients with Worse Renal Function One Year after Kidney Transplant: Elderly KTbot

A Comprehensive Review of Infections in Older Kidney Transplant Recipients

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