Renal transplantation in the elderly: Outcomes and recommendations

Camilleri, Brian; Pararajasingam, Ravi; Buttigieg, Jesmar; Halawa, Ahmed

doi:10.1016/j.trre.2020.100530

Cited by 8 publications

(9 citation statements)

References 115 publications

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“…Although the relative risk of mortality is increased in the elderly transplant recipient compared to younger transplant recipients, 38 it is reassuring to note that the absolute rates of death 1 year and 5 years posttransplantation among older recipients remains low. Pre-existing vascular disease is a major risk factor for adverse outcomes after transplantation, and careful evaluation and selection of the appropriate candidates is necessary to ensure optimal patient outcomes and use of this scarce resource.…”

Section: Discussionmentioning

confidence: 99%

“…Residual confounding effects may exist as details pertaining to the parameters of dialysis adequacy prior to transplantation and the reasons for the choice of pre-transplant dialysis modality were not collected routinely. Furthermore, frailty is a risk factor for poor outcomes post- While the relative risk of mortality is increased in the elderly transplant recipient compared to younger transplant recipients 39 , it is reassuring to note that the absolute rates of death one and five-years post transplantation among older recipients remains low. Pre-existing vascular disease is a major risk factor for adverse outcomes after transplantation and care evaluation and selection of the appropriate candidates is necessary to ensure optimal patient outcomes and utilisation of this scarce resource.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

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Factors Influencing Long-Term Patient and Allograft Outcomes in Elderly Kidney Transplant Recipients

Lim

et al. 2021

Kidney International Reports

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Introduction Individuals aged ≥65 years are increasingly prevalent on the waitlist for kidney transplantation, yet evidence on recipient and donor factors that define optimal outcomes in elderly patients after kidney transplantation is scarce. Methods We used multivariable Cox regression modeling to determine the factors associated with all-cause death, death with a functioning graft, and overall and death-censored graft survival, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Results A total of 802 kidney transplant recipients aged ≥65 years underwent their first transplantation between June 2006 and December 2016. Median age at transplantation was 68 years (interquartile range = 66−69 years). The 1-year and 5-year overall patient and graft survivals (95% confidence interval [CI]) were 95.1 (93.5−96.7) and 79.0 (75.1−82.9), and 92.9 (91.1−94.7) and 75.4 (71.3−79.5), respectively. Factors associated with higher risks of all-cause death included prevalent coronary artery disease (adjusted hazard ratio [95% confidence interval] = 1.47 [1.03–2.11]), cerebrovascular disease (1.99 [1.26–3.16]), increasing graft ischemic time (1.06 per hour [1.03–1.09]), donor age (1.02 per year [1.01–1.03]), delayed graft function (1.64 [1.13−2.39]), and peritoneal dialysis pretransplantation (1.71 [1.17–2.51]). Conclusion Prevalent vascular disease and peritoneal dialysis as a pretransplantation dialysis modality are risk factors associated with poorer outcomes in transplant recipients aged ≥65 years. Careful selection and evaluation of potential candidates may improve graft and patient outcomes in older patients.

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Section: Discussionmentioning

confidence: 99%

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Factors Influencing Long-Term Patient and Allograft Outcomes in Elderly Kidney Transplant Recipients

Lim

et al. 2021

Kidney International Reports

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“…El trasplante renal es la opción terapéutica preferida en pacientes con ERC terminal que presentan AAH, debido a que mejora los síntomas rápidamente [10,45]. Este procedimiento se puede realizar por medio de dos técnicas: la laparoscopia y la cirugía abierta.…”

Section: Tratamiento De La Aahunclassified

Amiloidosis Asociada a Hemodiálisis: Revisión Literaria

Bohórquez-Rivero

Sanchez-Martínez

Brieva-Deulofeut

et al. 2021

Rev. Colomb. Nefrol.

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La amiloidosis constituye una complicación importante en los pacientes con enfermedad renal crónica terminal que son sometidos a hemodiálisis durante extensos períodos de tiempo. Al igual que en otras amiloidosis sistémicas, la amiloidosis asociada a hemodiálisis está formada por diferentes sustancias, algunas de ellas de carácter fibrilar, como la ?eta-2-microglobulina, la cual representa una de las proteínas de mayor relevancia dada su implicación etiopatogénica. A pesar de que las técnicas de hemodiálisis han sido mejoradas con el paso de los años, dicha entidad continúa siendo una complicación relativamente frecuente; tal es que se puede presentar hasta en el 80% de los pacientes con hemodiálisis prolongadas. Por lo tanto, se hizo imprescindible realizar una revisión narrativa partiendo de la literatura científica disponible en las diferentes bases de datos con el objetivo de contribuir a mejorar y actualizar el conocimiento del médico en dicho tópico; abarcando desde los aspectos generales y su fisiopatología, hasta su presentación clínica, diagnóstico, y tratamiento.

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“…Transplantation in patients >65 years of age has increased globally in the last decade. 1,2 Despite potential differences in drug pharmacokinetics and patient responsiveness in the elderly, current immunosuppressant guidelines in transplant recipients do not have specific recommendations for dosing in elderly recipients or provide age-specific immunosuppressant targets. 3,4 It is not known if clinicians themselves make empirical adjustments to immunosuppressant treatment in the elderly, and if so, the nature of these adjustments.…”

Section: Introductionmentioning

confidence: 99%

“…Resultantly, the aim of this study was to compare immunosuppressant drug prescribing differences between elderly and younger adult renal transplant recipients across Australia and New Zealand from 2000 to 2015. Specific objectives were to (1) compare the immunosuppressant drug choice and doses used initially to the drugs and doses used at 1 year, between elderly and younger adult transplant recipients and (2) to identify any associations between choice of immunosuppressant drug and number of immunosuppressant drugs prescribed on graft survival in elderly recipients.…”

Section: Introductionmentioning

confidence: 99%

Immunosuppressant prescribing patterns in elderly kidney transplant recipients using registry data from Australia and New Zealand

Cossart

Cottrell

McStea

et al. 2022

Pharmacy Practice and Res

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Background The elderly is the fastest growing kidney transplant recipient group; however, they are more likely to die from immunosuppressant side effects than graft failure. Aim The aim of this study was to explore immunosuppressant prescribing practices in elderly kidney transplant recipients. Method We conducted a retrospective audit of registry data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry between 2000 and 2015, to determine the actual prescribing trends of immunosuppressant drugs in elderly recipients (≥65 years). Drug choice and doses, prescribed initially and at 1‐year, were examined, with a survival analysis conducted to determine if drug regimen influenced graft survival. Results Six hundred and one elderly recipients were included in the analysis. Elderly patients were less likely to be prescribed tacrolimus at 1 year than younger patients, and median doses (149.3 vs 155.6 micrograms/kg; p < 0.05) were significantly lower in elderly patients across the timeframe (initially and at 1‐year post‐transplant). We also observed that elderly recipients prescribed dual immunosuppressant therapy (compared to triple therapy) had an increased risk of graft loss (p < 0.05). Conclusion By examining Registry data across a 15‐year span, we observed differences in both immunosuppressant usage and drug dosing trends in elderly recipients. The implications of these findings may suggest that guidelines need adjustment to reflect this.

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Renal transplantation in the elderly: Outcomes and recommendations

Cited by 8 publications

References 115 publications

Factors Influencing Long-Term Patient and Allograft Outcomes in Elderly Kidney Transplant Recipients

Factors Influencing Long-Term Patient and Allograft Outcomes in Elderly Kidney Transplant Recipients

Amiloidosis Asociada a Hemodiálisis: Revisión Literaria

Immunosuppressant prescribing patterns in elderly kidney transplant recipients using registry data from Australia and New Zealand

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