Renal transplantation in the elderly: does patient age determine the results?

Otero-Raviña, Fernando; Rodríguez-Martínez, Mónica; Gude, Francisco; González-Juanatey, José Ramón; Valdés, F; Sánchez-Guisande, D

doi:10.1093/ageing/afi200

Cited by 18 publications

(6 citation statements)

References 12 publications

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“…Previous studies in elderly kidney transplant recipients have also shown that the major cause of graft loss among this age group is death with functioning graft (20–25). As our experience shows, elderly recipients have excellent death‐censored graft survival that is comparable to that of younger patients (20, 23–29). Although the cause of death could not be ascertained from our records in 42.3% of the cases, we suspect that cardiovascular disease played a significant role as overall it was the main identifiable cause of death.…”

Section: Discussionmentioning

confidence: 64%

The impact of reduced immunosuppression on graft outcomes in elderly renal transplant recipients

Badowski

Gurk-Turner

Cangro³

et al. 2009

Clinical Transplantation

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Optimal immunosuppression (IS) for elderly kidney transplant recipients is unknown. We conducted a retrospective cohort study of recipients aged 60 yr or older to examine the impact of reduced IS on graft outcomes. Group 1 patients (n = 101) were initiated on mycophenolate mofetil 2 g/d and tacrolimus, target level 10-12 ng/mL; Group 2 patients (n = 88) with 1 g/d and 8-10 ng/mL, respectively. Dose adjustments were made as required. The groups were comparable except for diabetes, end-stage renal disease duration, and induction. Mycophenolate mofetil dose was reduced in 62% and 38% of the patients, respectively (p < 0.01). Patients were followed for 23.8 +/- 14.2 and 21.3 +/- 11.8 months post-transplant (p = 0.2). Twenty-seven cases in Group 1 (26.7%) and eight in Group 2 (9.1%) lost their grafts (p = 0.01); 19 (18.8%) and 7 (8.0%) cases in each group because of death, respectively (p = 0.09). Sixteen patients in Group 1 (15.8%) and 18 in Group 2 (20.5%) experienced acute rejection (p = 0.36). Patients in Group 2 had a lower risk of graft loss compared with those in Group 1 [adjusted hazard ratio (HR): 0.27, p = 0.006, 95% CI: 0.11-0.69]. There were no significant differences between the groups regarding graft function, BK virus nephropathy, and CMV infection. Our results suggest that reduction in overall IS in this group was associated with improved graft and patient survival.

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Section: Discussionmentioning

confidence: 64%

The impact of reduced immunosuppression on graft outcomes in elderly renal transplant recipients

Badowski

Gurk-Turner

Cangro³

et al. 2009

Clinical Transplantation

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“…Recent studies corroborate these results, with good survival of both the patient and graft, provided adequate selection and preparation of the elderly graft recipient are made [22,23]. Patient and graft survival are determined by recipient comorbidity rather than age [24]. …”

Section: Discussionmentioning

confidence: 85%

Factors Predicting Mortality in Elderly Patients on Dialysis

et al. 2010

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Elderly patients are increasingly enrolled in dialysis programs and present a series of special characteristics due to their high morbidity and mortality. Objective:To describe the characteristics of incident dialysis patients aged >75 years, their comorbidities and their admissions, with a view to determining the factors that influence their course and mortality. Patients and Methods: The study included all patients aged >75 years who started dialysis in our center since January 2000. The mean duration of follow-up was 3.3 ± 2.2 years. Data were collected on incident comorbidity, admissions and their causes. A total of 139 patients were included, with a mean age of 78.6 ± 2.6 years (67.6% males, 33.8% diabetic and 7.9% on peritoneal dialysis). Three groups were established according to age: 75–79, 80–85 and >85 years. The most frequent comorbidities were chronic obstructive pulmonary disease (25.9%), ischemic heart disease (25.2%), heart failure (25.9%), neoplasms (23.7%), peripheral vascular disease (23.7%), cerebrovascular disease (18.7%) and arterial hypertension (81%). The Charlson index was calculated, not adjusted for age, and comorbidity tertiles were established. Results: During follow-up, the patients presented 0.82 ± 0.99 admissions/patient/year, with a duration of 12.1 ± 20.6 days/patient/year. The main causes of admission were infection (33%), vascular access problems (27%) and peripheral vascular events (14%). A total of 61 patients died (44%), and 4 underwent kidney transplantation (2.9%). The mean duration of follow-up of the transplanted patients was 3.6 ± 1.8 years. The main causes of death were infection (32%), cardiovascular problems (28.3%) and neoplastic disease (11.3%). The global survival rate was 90, 82 and 53% after 1, 2 and 5 years, respectively. No significant differences in survival or annual admission rate were found in relation to age group and dialysis technique. In contrast, the annual admission rate and days of admission were directly correlated to the Charlson index (p = 0.009 and p = 0.032, respectively). No significant differences in the Charlson index were found between the patients on hemodialysis and those subjected to peritoneal dialysis. In the univariate model, the factors associated to mortality were diabetes, chronic obstructive pulmonary disease, heart failure and the Charlson index. In the multivariate model, only the Charlson index remained as an independent predictive factor (p = 0.006). Conclusions: Unlike the general population, age does not influence mortality or admissions in elderly patients on dialysis. Incident comorbidity is the factor exerting the greatest influence upon mortality and admissions. Advanced age in itself should not be regarded as an excluding factor for starting dialysis.

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“…The elderly group received organs from older donors when compared to the younger group, although at the five yr follow‐up, the graft survival was not different from the younger recipients. Elderly recipients receiving kidneys from older donors may have poorer outcomes due to a higher rate of chronic allograft nephropathy and consequently increased renal graft loss (14–17). Although reports have also shown that those patients still presented better survival when compared to dialysis (6, 9, 10).…”

Section: Discussionmentioning

confidence: 99%

Renal transplantation outcomes: a comparative analysis between elderly and younger recipients

Mendonça

Reis

Sesso

et al. 2007

Clinical Transplantation

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Renal transplantation is presently the best treatment for end-stage renal disease, although considered contraindicated for elderly patients. However, more investigation is needed due to higher life expectancy rates of the general population and the increasing number of over 60-yr-old patients with chronic renal failure dependent upon dialysis. This study aims to determine graft and patient survival rates of renal transplant patients 60 yr and older compared to a younger group (50-59 yr old). Relevant pre- and post-transplant clinical data related to graft and patient survival in both groups were also investigated. Three-hundred and twenty consecutive renal transplant patients were enrolled in this study and grouped based on age at the time of the transplantation: one-hundred and ten patients at or over 60 yr old (elderly group) and 210 patients ranging from 50 to 59 yr old (younger group). There were no statistical differences in either group regarding clinical characteristics and immunological risk factors. The incidence of acute rejection was higher in the younger group (37.6%) than in the elderly (22.7%) (p = 0.01). Censored to death graft survivals at five yr were respectively 86.7% for patients > or = 60 yr and 82.1% for patients 50-59 yr old (p = 0.49). Patient survival rates at five yr were respectively 76.2% for patients > or = 60 yr and 81.6% for patients 50-59 yr old (p = 0.33). Our data show that renal transplantation for elderly patients has similar results to those found in younger individuals, which does not make age, in and of itself, a contraindication for transplantation.

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Renal transplantation in the elderly: does patient age determine the results?

Abstract: Recipient age alone cannot be a criterion to exclude patients over 60 years from transplantation, since their lower survival is influenced by comorbidity and the donor's age.

Cited by 18 publications

References 12 publications

The impact of reduced immunosuppression on graft outcomes in elderly renal transplant recipients

The impact of reduced immunosuppression on graft outcomes in elderly renal transplant recipients

Factors Predicting Mortality in Elderly Patients on Dialysis

Renal transplantation outcomes: a comparative analysis between elderly and younger recipients

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