Older Age is Associated With Lower Utilization of Living Donor Kidney Transplant

Raissi, Afsaneh; Bansal, Aditya; Ekundayo, Oladapo; Bath, Sehajroop; Edwards, Nathaniel; Famure, Olusegun; Kim, Sang Joseph; Mucsi, István

doi:10.1016/j.ekir.2022.11.002

Cited by 5 publications

(3 citation statements)

References 58 publications

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“…In a recent publication, about 30% of nephrologists considered age as an important reason for not referring to a transplantation center [28], while the KDIGO guideline clearly states that age by itself is not a barrier [29]. Late referral is one of the reasons why a substantial part of elderly patients (30% in a previous study from our center) are delisted before transplantation [30,31]. Also, old age is associated with lower utilization of living donor kidney transplantation [30].…”

Section: Discussionmentioning

confidence: 99%

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Transplant Candidates of 70+ Years Have Superior Survival If Receiving Pre-Emptively a Living Donor Kidney

Betjes,

Kho,

Roodnat

et al. 2024

JCM

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Background: The number of kidney transplant recipients over 70 years of age is increasing but detailed data on patient and graft survival in the modern era of immune suppression are few. Methods: A single-center cohort of patients of 70 years and older (n = 349) at time of kidney transplantation from 2010–2020 were followed until January 2023. Results: The median age was 73 years with a median follow-up of 4.3 years. Fifty percent of recipients of a living donor kidney (LDK, n = 143) received their graft pre-emptively. Cumulative death-censored graft survival was excellent in the LDK group and reached 98% at 5 years vs. 85% in the deceased donor kidney (DDK) group. Primary non-function (38%) and rejection (43%) were the major causes of graft loss in the first year after DDK transplantation. Rejection-related graft loss was 4.6% during follow-up. Median recipient survival was superior in the subgroup of pre-emptively transplanted LDK patients compared to non-pre-emptively LDK transplanted patients (11.1 versus 6.2 years). Non-pre-emptively transplanted patients had a significantly increased incidence of infection (HR 3.81, 1.46–9.96) and cardiovascular-related causes of death (HR 3.35, 1.16–9.71). Pre-emptive transplantation was also associated with a significantly improved graft survival in the DDK recipients but this result was confounded by significantly better HLA matching and younger donor age in this group. Conclusions: Pre-emptive LDK transplantation in patients of 70 years or older confers superior graft and recipient survival.

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Section: Discussionmentioning

confidence: 99%

“…Also, old age is associated with lower utilization of living donor kidney transplantation [30]. Agism and socio-economic factors seem important determinants for the underused option of kidney transplantation in the elderly [14,28,31,32].…”

Section: Discussionmentioning

confidence: 99%

Transplant Candidates of 70+ Years Have Superior Survival If Receiving Pre-Emptively a Living Donor Kidney

Betjes,

Kho,

Roodnat

et al. 2024

JCM

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“…Avoiding an inflamed allograft due to ischemic reperfusion injury lowers the risk of acute rejection, with delayed graft function being a rarer event and, on average, having a better graft function. Currently, the frequency of transplantation with a living donor kidney is much lower in older adults and is an underused option ( 153 , 154 ). Data indicate that the kidneys of an older donor show almost similar excellent graft survival as the kidneys of a young donor ( 155 ).…”

Section: Managing Maintenance Immune Suppression Regimens In Relation...mentioning

confidence: 99%

Lowering maintenance immune suppression in elderly kidney transplant recipients; connecting the immunological and clinical dots

Betjes

Weerd

2023

Front. Med.

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The management of long-term immune suppressive medication in kidney transplant recipients is a poorly explored field in the area of transplant medicine. In particular, older recipients are at an increased risk for side effects and have an exponentially increased risk of infection-related death. In contrast, an aged immune system decreases the risk of acute T-cell-mediated rejection in older recipients. Recent advances in alloimmunity research have shown a rapid and substantial decline in polyfunctional, high-risk CD4+ T cells post-transplantation. This lowers the direct alloreactivity responsible for T-cell-mediated rejection, also known as donor-specific hyporesponsiveness. Chronic antibody-mediated rejection (c-aABMR) is the most frequent cause of kidney graft loss in the long term. However, in older adults, c-aABMR as a cause of graft loss is outnumbered by death with a functioning graft. In addition, DSA development and a diagnosis of c-aABMR plateau ~10 years after transplantation, resulting in a very low risk for rejection thereafter. The intensity of immune suppression regimes could likely be reduced accordingly, but trials in this area are scarce. Tacrolimus monotherapy for 1 year after transplantation seems feasible in older kidney transplant recipients with standard immunological risk, showing the expected benefits of fewer infections and better vaccination responses.

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Ageism revisited

Ribera-Casado

2024

Eur Geriatr Med

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Older Age is Associated With Lower Utilization of Living Donor Kidney Transplant

Cited by 5 publications

References 58 publications

Transplant Candidates of 70+ Years Have Superior Survival If Receiving Pre-Emptively a Living Donor Kidney

Transplant Candidates of 70+ Years Have Superior Survival If Receiving Pre-Emptively a Living Donor Kidney

Lowering maintenance immune suppression in elderly kidney transplant recipients; connecting the immunological and clinical dots

Ageism revisited

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