Renal Transplantation in Patients Older Than 60 Years With High Comorbidity. Is There a Survival Benefit? A Multicenter Study in Argentina

Abstract

Background. The impact of renal transplantation (RT) in the elderly with many comorbid conditions is a matter of concern. The aim of our study was to assess the impact of RT on the survival of patients older than 60 years compared with those remaining on the waiting list (WL) according to their comorbidities. Methods. In this multicentric observational retrospective cohort study, we included all patients older than 60 years old admitted on the WL from 01 January 2006 to 31 December 2016. The Charlson comorbidity index (CCI) score was calculated for each patient at inclusion on the WL. Kidney donor risk index was used to assess donor characteristics. Results. One thousand and thirty-six patients were included on the WL of which 371 (36%) received an RT during a median follow-up period of 2.5 (1.4–4.1) years. Patient survival was higher after RT compared to patients remaining on the WL, 87%, 80%, and 72% versus 87%, 55%, and 30% at 1, 3, and 5 years, respectively. After RT survival at 5 years was 37% higher for patients with CCI ≥ 3, and 46% higher in those with CCI < 3, compared with patients remaining on the WL. On univariate and multivariate analysis, patient survival was independently associated with a CCI of ≥3 (hazard ratio 1.62; confidence interval 1.09-2.41; P < 0.02) and the use of calcineurin-based therapy maintenance therapy (hazard ratio 0.53; confidence interval 0.34-0.82; P < 0.004). Conclusions. Our study showed that RT improved survival in patients older than 60 years even those with high comorbidities. The survival after transplantation was also affected by comorbidities.

Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis

“…We identified 48 studies eligible for this systematic review. 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 After data extraction and further screening, we found 18 studies containing sufficient non-overlapping outcome data suitable for meta-analysis. 24 27 30 31 32 33 34 36 42 48 50 52 61 62 64 66 67 68 Figure 1 shows a PRISMA flow diagram detailing the process of study selection.…”

“…In all cases, where respective comparisons were available, studies reported living donor transplantation as conferring a greater survival benefit over deceased donor transplantation, 31 35 45 49 55 59 60 61 63 standard criteria donors over extended criteria donors, 41 47 55 60 69 and finally hepatitis C virus seronegative over hepatitis C virus seropositive donor transplantation. 37 65 Detailed outcome data with adjusted hazard ratios for each study and stratum are provided in supplementary table D. Benefit was found in all adults aged ≥18, older adults (≥60, 24 28 29 38 47 66 67 ≥65, 28 55 58 61 and ≥70 45 50 62 ), and population groups with obesity (body mass index ≥30), 35 diabetes as a comorbidity, 43 44 58 systemic sclerosis, 39 peripheral arterial disease, 43 60 and patients seropositive for hepatitis C virus. 65 …”

Effect of age and care organization on sources of variation in kidney transplant waiting list registration

“…However, with elderly patients, the risk-benefit ratio should be carefully discussed. 12,28 This implies an additional procedure to identify risk factors such as silent cancer, cardiovascular disease, or infection. This preregistration assessment may take time.…”

“…According to French guidelines, up to the age of 85, age alone should not be a barrier to waitlisting. However, with elderly patients, the risk‐benefit ratio should be carefully discussed 12,28 . This implies an additional procedure to identify risk factors such as silent cancer, cardiovascular disease, or infection.…”

Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?

“…It is demonstrated that KT provides superior life expectancy [61][62][63] and QoL [64][65][66] than dialysis. Nonetheless, returning to dialysis after a failed transplant entails a greater risk of death than starting RRT for the first time [11,40,43,67,68].…”