Predicting clinical outcome in the elderly renal transplant recipient

Doyle, S.; Matas, Arthur J.; Gillingham, Kristen J.; Rosenberg, Mark E.

doi:10.1046/j.1523-1755.2000.00066.x

Cited by 100 publications

(75 citation statements)

References 13 publications

(7 reference statements)

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“…[3][4][5] Several studies have reported that graft and patient survivals were lower among patients 60 years or older, when compared with recipients aged 18 to 59. 6,7 On the other hand, similar results between older and younger groups were observed for death censored graft survival and in both graft and patient survivals among the elderly with low-risk profiles. 6 In a study comparing the survival rates of recipients older than 65 years to those aged between 60 to 64 or 50 to 59 years, after adjusting for confounders, the authors did not find significant differences for 5-year graft survival by age group.…”

Section: Discussionsupporting

confidence: 73%

“…6,7 On the other hand, similar results between older and younger groups were observed for death censored graft survival and in both graft and patient survivals among the elderly with low-risk profiles. 6 In a study comparing the survival rates of recipients older than 65 years to those aged between 60 to 64 or 50 to 59 years, after adjusting for confounders, the authors did not find significant differences for 5-year graft survival by age group. 8 Other investigators found similar 5-year graft survivals between the oldest patients (Ͼ60 years) and the youngest group (20 -29 years).…”

Section: Discussionsupporting

confidence: 73%

“…In a recent study the older patients without these risk factors had patient and graft survival equivalent to younger recipients. 6,8 Careful selection of older candidates along with a complete assessment of cardiac and infectious risk as well as tailored immunosuppression may improve survival in elderly patients. 12 Some authors have argued that the better results reported in some series of older recipients may be due to less acute rejection in elderly recipients.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Pedroso

Martins

Fonseca

et al. 2006

Transplantation Proceedings

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The prevalence of end-stage renal disease (ESRD) increases with advancing age. In most countries renal transplant recipients are getting older, too. Transplantation must be considered for ESRD patients older than 60 years; however, there are few data regarding outcomes in this population. We retrospectively reviewed the clinical course of recipients aged Ն60 years (n ϭ 43) who underwent primary or repeated grafts from August 1988 to December 2004. We then compared recipient and donor characteristics as well as graft and patient survivals with recipients aged 18 to 59 years (n ϭ 1058) who were transplanted during the same time. Donor age tended to be higher among the oldest recipient group (P Ͻ .001). Mean follow-up was significantly shorter in the group aged Ն60 years (P Ͻ .001), as our institution only recently has frequently accepted patients Ն60 years. Older recipients showed more frequent delayed graft function (P ϭ .007), longer initial hospitalization (P ϭ .005), and a significantly lower incidence of posttransplant acute rejection episodes (P ϭ .015). Patient (P ϭ .057), graft (P ϭ .407), and death-censored graft (P ϭ .649) survivals were not different between the two groups. Seven recipients aged Ն60 years died; the main cause of which was cardiovascular in origin. The loss of organs (n ϭ 11) in the older patients was mainly due to death with a functioning kidney (54.5%). Our results confirm that renal transplant must be considered in selected patients older than 60 years as patient and graft survivals are similar to those of younger patients. E LDERLY PATIENTS are the fastest growing population in dialysis programs. 1 Hemodialysis is the more commonly used modality, although it is associated with significant morbidity, mortality, and a poor quality of life. The prevalence of end-stage renal disease (ESRD) increases with advancing age. In most countries, renal transplant recipients are also getting older. In the precyclosporine era the unsatisfactory results of grafting in the elderly lead to the exclusion of patients more than 60 years of age due to higher risks for patient death and graft loss. 2 With widespread use of calcineurin inhibitors, the age limit for transplantation has expanded. Today, transplantation is considered the best treatment option for ESRD patients regardless of age when compared with dialysis. [3][4][5] With the development of new immunosuppressive alternatives, transplantation is safe and successful. It should be considered an alternative to dialysis even among older patients. Older ESRD patient survival after transplantation is higher than on the waiting list. [3][4][5] However, the organ donor shortage makes clinicians reluctant to transplant kidneys into older patients. Controversy has emerged regarding the appropriateness of transplantation in this patient group with a shortened life expectancy. Numerous studies have reported worse patient and graft survivals in older patients compared with younger patients, while other analyses did not find any difference. 6 -9 The...

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Pedroso

Martins

Fonseca

et al. 2006

Transplantation Proceedings

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“…Meier-Kriesche reports a 1-year survival of 81% from their single-center series of patients older than 60 years (8), and Palomar and Doyle report comparable figures for this age group with 78% and 86%, respectively (9). For patients of 65 years and greater with donors older than 65 years, Smits reports a 1-year graft survival of 79% (6).…”

Section: Discussionmentioning

confidence: 93%

Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

Fritsche¹,

Hörstrup

Budde³

et al. 2003

American Journal of Transplantation

115

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Allocation of kidneys from donors older than 64 years to recipients older than 64 years was started in 1999 to improve use of older donor kidneys. Kidneys are allocated locally without HLA-matching to keep cold ischemia short.We compared survival and rejection rates in elderly patients allocated in the old-for-old program (ESP) to patients aged 60 years and older based on HLA-matching, expected ischemia and waiting time (ETKAS).The 69 ESP patients were older (67.9 ± ± 2.5 vs. 63.9 ± ± 2.9 years), had older donors (71.2 ± ± 3.9 vs. 44.6 ± ± 14.5 years) and more HLA-mismatches (4.2 ± ± 1.2 vs. 1.6 ± ± 1.7) than the 71 ETKAS patients, while ischemia was shorter (7.8 ± ± 3.4 vs. 14.2 ± ± 5.5 h). ESP and ETKAS had similar graft (1-year: 83.6% vs. 86.9%) and patient survival (85.2% vs. 89.5%). With the introduction of ESP, use of older recipients and donors rose from less than 2% to 16% and 11%, respectively. Incidence of acute rejections was significantly higher in the ESP group (1 year: 43.2% vs. 27.4%) and significantly correlated with the degree of HLA-matching.Introduction of old-for-old allocation allows successful expansion of the donor and recipient pool without affecting patient and graft survival. HLA-matching should not be ignored, as the risk of acute rejection in elderly patients is substantial.

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“…Wolfe et al [29] compared the survival of primary deceased donor transplant recipients with other dialysis patients and found that among renal transplant recipients patients aged 60-74 years, the cumulative survival rate improved after the first year post-transplantation. More recent studies indicate that in elderly ESRD patients, survival at 1, 5, and 10 years is approximately 80% to 90%, 70%, and 50% respectively [38][39][40][41][42][43][44][45][46]. In the United States there are currently over 16,000 ESRD patients older than 65 years waiting for a kidney transplantation, representing 18% of all listed candidates [1].…”

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confidence: 99%

It is not polite to ask a dialysis patient his age!

2011

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Predicting clinical outcome in the elderly renal transplant recipient

Abstract: Renal transplantation is a safe and effective therapy for the older renal failure patient. In the absence of identified risk factors, graft survival is equivalent to that seen in younger patients.

Cited by 100 publications

References 13 publications

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

It is not polite to ask a dialysis patient his age!

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