Renal Transplantation in Recipients Over the Age of 60

Başar, Halil; Soran, Atilla; Shapiro, Ron; Vivas, Carlos; Vp, Scantlebury; Ml, Jordan; Ha, Gritsch; McCauley, Jerry; Randhawa, Parmjeet; Irish, William; Tr, Hakala; Fung, John J.

doi:10.1097/00007890-199904270-00019

Cited by 110 publications

(54 citation statements)

References 11 publications

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“…Contradicting this idea, Basar et al 20 clearly showed inferior outcomes when elderly donor grafts were used in older recipients, seeming that there is an added phenomenon of harmful factors. Based on our results, we recommend an old-for-old program, 13 where ABO-compatible organs from elderly donors with a negative cross-match, are locally allocated to old recipients.…”

Section: Discussionmentioning

confidence: 99%

Do Elderly Patients Deserve a Kidney Graft?

Nunes

Mota

Parada

et al. 2005

Transplantation Proceedings

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Purpose. Compare renal transplant long-term outcomes among recipients aged 60 years or older with those in younger patients. Patients and methods. We analyzed 103 transplants in recipients above 60 years of age for the influence of key factors related to the graft and patient. The results were compared with 1060 transplant recipients aged 18 to 59 years. Results. The mean ages were 62.93 and 40.35 years for the older and younger group. The older group showed a higher prevalence of obesity and unknown etiologies for the end-stage renal disease. Important comorbidity was significantly more frequent among recipients aged more than 60 years, mainly of a cardiovascular nature (56% vs 18.5%). Donor age (39.75 vs 31.59 years), cold ischemia time (22.43 vs 20.49 hours) and human leukocyte antigen compatibilities (2.59 vs 2.36) were significantly greater in the older subset. After a mean follow-up of 4.72 and 6.07 years for the older versus younger group, we found no differences in initial graft function, acute rejection rate, and serum creatinine/clearance. Patient and graft survivals at 1, 5, and 10 years were lower among the 60ϩ group. There were no differences in graft survival censored for death with a functioning graft, namely, 95.1%, 89.4%, and 81.2% for the 60ϩ cohort. The main cause of graft loss in the older group was death with a functioning graft. Conclusion. Renal transplantation should be considered for selected patients older than 60 years. Despite a shorter life expectancy, they benefit from it similar to younger recipients. T HE INCIDENCE OF end-stage renal disease (ESRD)increases with advancing age. Patients older than 60 years represent between 53% and 66% of the population requiring renal replacement therapies.1 Therapy for ESRD in the elderly is characterized by tremendous challenges, raising medical, ethical, and socioeconomic concerns. Hemodialysis, the most frequently used renal replacement modality in these patients, is associated with significant morbidity, mortality, and a poor quality of life.2,3 The great organ shortage, higher comorbidity rate, and shorter life expectancy make the allocation of kidneys to this population controversial.Nevertheless, transplantation is the gold standard treatment for ESRD patients. With immunosuppression based upon calcineurin inhibitors, it has become a feasible alternative for the elderly population. 4 -7 Compared with hemodialysis, renal transplantation is associated with a 61% decrease in the long-term risk of death and an additional 4-year life expectancy for patients over 60 years. 4 In this retrospective study, we report a single-center, long-term follow-up of kidney transplants in patients above

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Section: Discussionmentioning

confidence: 99%

Do Elderly Patients Deserve a Kidney Graft?

Nunes

Mota

Parada

et al. 2005

Transplantation Proceedings

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“…However, there is controversy regarding the outcomes with older kidneys. 7,15,16 Donor age was significantly higher in our older recipients. We analyzed the outcome of our elderly patients according to donor's age and failed to observe a significant difference in actuarial patient and graft survivals when comparing older recipients of kidneys from an aging donor.…”

Section: Discussionmentioning

confidence: 69%

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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“…The aging causes a series of morphological and physiological changes to the kidneys leading to an increased glomerular, vascular, and tubular senescence [31,32]. Such morphological changes can result in significant functional changes including a decrease in renal blood flow and glomerular filtration rate, leading to an overall deterioration in renal function [6].…”

Section: The Marginal Kidneymentioning

confidence: 99%

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

Rosa

Muscogiuri

Sarno

2013

ISRN Transplantation

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Kidney transplantation (KT) is the therapy of choice for end-stage renal disease (ESRD). The ESRD population is aging and so are patients waiting for KT. New strategies have been made for increasing the donor and recipient pools, and as a consequence kidneys from older donors or donors with significant comorbidities, the so-called "expanded criteria donor" (ECD) kidneys, are used for transplantation. Although good outcomes have been achieved from ECD, several issues are still waiting for clarification and need to be discussed. The concept of age matching is accepted as a method to ameliorate utilization of these allografts, but an optimal and widely accepted strategy is still not defined. The development of machine perfusion and the dual kidney transplantation are techniques which further improve the outcome of transplants from ECD, but the described experiences are scarce or coming from small single institutional reports. Also due to age-related immune dysfunction and associated comorbidities, the elderly recipients are more susceptible to immunosuppression related complications (e.g., infections and malignancy), although a widely accepted and validated immunosuppressive regimen is still lacking. In this paper, we review the issues related to KT employing allografts from marginal donors with a particular interest for the elderly patients.

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Renal Transplantation in Recipients Over the Age of 60

Abstract: Although the overall outcomes of transplantation in older recipients remain reasonable, the inferior outcomes with older donor kidneys call into question proposals to utilize older donor kidneys preferentially in older recipients.

Cited by 110 publications

References 11 publications

Do Elderly Patients Deserve a Kidney Graft?

Do Elderly Patients Deserve a Kidney Graft?

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

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

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