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

Abstract

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.

Optimising Treatment of End-Stage Renal Disease in the Elderly

“…Although numerous studies have shown that older age per se does not adversely influence allograft outcomes [64], data suggest higher rates of surgical complications in elderly recipients [65,66] and caution is advised regarding the intensity of immunosuppression and the attendant risk of infectious complications [67] and post-transplant malignancy [68]. There are few, heterogeneous studies examining the impact of transplantation on QoL in elderly recipients and those undergoing transplantation represent a highly selected group manifesting a degree of physical health and psychological motivation.…”

Pharmacokinetics and pharmacodynamics of immunosuppressive drugs in elderly kidney transplant recipients

“…Studies from individual centers and registry data analyses show that the incidence of acute rejection decreases steadily with increasing recipient age (Fig. 2) [19][20][21][22]. In a recent analysis of more than 100,000 renal transplant recipients from the United Network for Organ Sharing (UNOS) database, Tullius and Milford [23] confirmed these findings.…”

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“…Survival analysis was performed by Kaplan-Meier curve and log-rank tests. Linear mixed models were used to analyze creatinine, eGFR, urine protein/creatinine ratio, and lipid profile over time (1,3,6, and 12 months), with group as a fixed factor. Multivariate binary logistic regression was carried out for risk factors associated with infection by CMV.…”

“…1 These benefits have also been observed in high cardiovascular risk populations such as the elderly. [2][3][4][5][6] Compared with their younger counterparts, older individuals have a significantly lower risk for acute rejection, but show a greater risk of infection and malignancy, as well as a particular vulnerability to the immunosuppressive medications used in renal transplant.…”