Survival benefit of renal transplantation in octogenarians

Ravichandran, Bharath; Sparkes, Tracy; Masters, B.; Thomas, Beje; Demehin, Moses; Bromberg, Jonathan S.; Haririan, Abdolreza

doi:10.1111/ctr.14074

Cited by 5 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has resulted in an increase in number of kidney transplant referrals and surgeries for octogenarians 21. While overall post-transplant survival in very elderly kidney transplant recipients aged ≥80 has been reported to be lower than younger patients, studies have demonstrated that survival is still improved compared with remaining dialysis dependent 12 22. Octogenarians with ESKD experience a rapid loss of functional status and quality of life 23.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, very elderly patients with ESKD have high mortality with a median survival after dialysis initiation in the USA of 15.6 months for patients aged 80–84 and 11.6 months for patients aged 85–89 5. While several studies have demonstrated that kidney transplantation has excellent outcomes, including patient and graft survival, in carefully selected octogenarians,12 22 24 there have been concerns regarding increased perioperative mortality, length of hospital stay, rates of graft loss in very elderly kidney transplant recipients aged ≥80 as well as the need to balance recipient benefit with the ongoing organ shortage 25–28. A prior study of Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing database (UNOS) database of 471 octogenarians transplanted between 1988 and 2013 demonstrated increased risk of graft failure and decreased survival among this patient population 25.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Distinct phenotypes of kidney transplant recipients aged 80 years or older in the USA by machine learning consensus clustering

Jadlowiec

Mao

et al. 2023

BMJ Surg Interv Health Technologies

View full text Add to dashboard Cite

ObjectivesThis study aimed to identify distinct clusters of very elderly kidney transplant recipients aged ≥80 and assess clinical outcomes among these unique clusters.DesignCohort study with machine learning (ML) consensus clustering approach.Setting and participantsAll very elderly (age ≥80 at time of transplant) kidney transplant recipients in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database database from 2010 to 2019.Main outcome measuresDistinct clusters of very elderly kidney transplant recipients and their post-transplant outcomes including death-censored graft failure, overall mortality and acute allograft rejection among the assigned clusters.ResultsConsensus cluster analysis was performed in 419 very elderly kidney transplant and identified three distinct clusters that best represented the clinical characteristics of very elderly kidney transplant recipients. Recipients in cluster 1 received standard Kidney Donor Profile Index (KDPI) non-extended criteria donor (ECD) kidneys from deceased donors. Recipients in cluster 2 received kidneys from older, hypertensive ECD deceased donors with a KDPI score ≥85%. Kidneys for cluster 2 patients had longer cold ischaemia time and the highest use of machine perfusion. Recipients in clusters 1 and 2 were more likely to be on dialysis at the time of transplant (88.3%, 89.4%). Recipients in cluster 3 were more likely to be preemptive (39%) or had a dialysis duration less than 1 year (24%). These recipients received living donor kidney transplants. Cluster 3 had the most favourable post-transplant outcomes. Compared with cluster 3, cluster 1 had comparable survival but higher death-censored graft failure, while cluster 2 had lower patient survival, higher death-censored graft failure and more acute rejection.ConclusionsOur study used an unsupervised ML approach to cluster very elderly kidney transplant recipients into three clinically unique clusters with distinct post-transplant outcomes. These findings from an ML clustering approach provide additional understanding towards individualised medicine and opportunities to improve care for very elderly kidney transplant recipients.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distinct phenotypes of kidney transplant recipients aged 80 years or older in the USA by machine learning consensus clustering

Jadlowiec

Mao

et al. 2023

BMJ Surg Interv Health Technologies

View full text Add to dashboard Cite

show abstract

“…A few recent European publications have suggested that recipients aged >65 years may not obtain a survival benefit from KT compared with remaining on dialysis [3,4]. In contrast, other studies have reinforced the benefit of transplantation among elderly candidates aged >60 years [10], 70–75 years [11,12], and even 80 years [13].…”

Section: Introductionmentioning

confidence: 99%

“…However, the cDCD‐KT results were not evaluated in these studies. Although most of the available evidence supports the practice of KT for elderly recipients [10–13], concerns have been raised about outcomes when using organs from cDCD donors in this population [3,4]. Thus, an analysis of the results is needed.…”

Section: Introductionmentioning

confidence: 99%

Kidney transplant outcomes in elderly recipients with controlled donation after circulatory death or donation after brain death donors: a registry cohort study

Pérez‐Sáez

Juega

Zapatero

et al. 2021

Transplant International

View full text Add to dashboard Cite

Summary The number of kidney transplant (KT) procedures with controlled donation after circulatory death (cDCD) donors has exponentially increased in Spain in recent years, with a parallel increase in donor and recipient acceptance criteria. The outcomes of cDCD‐KT have been reported to be comparable to those of KT with donation after brain death (DBD) donors. However, studies in elderly recipients have yielded contradictory results. We performed a registry analysis of 852 KT recipients aged ≥65 years (575 in the DBD‐KT group, 277 in the cDCD‐KT group) in Catalonia, Spain. Clinical outcomes and survival were compared between DBD‐KT and cDCD‐KT recipients. The donor and recipient ages were similar between the two groups (71.5 ± 8.7 years for donors, 70.8 ± 4.1 years for recipients). Delayed graft function (DGF) was more frequent among cDCD‐KT recipients, without a difference in the rate of primary nonfunction. The 3‐year patient and death‐censored graft survival rates were similar between DBD‐KT and cDCD‐KT recipients (78.8% vs. 76.4% and 90.3% vs. 86.6%, respectively). In multivariable analysis, previous cardiovascular disease and DGF were independent risk factors for patient death. The type of donation (cDCD vs. DBD) was not an independent risk factor for patient survival or graft loss. cDCD‐KT and DBD‐KT provide comparable patient and graft survival in elderly recipients.

show abstract

“…In this Special Issue, Zompolas et al conducted a retrospective study to evaluate outcomes of 85 kidney transplant recipients aged ≥ 75 years in the Eurotransplant Senior Program from January 2010 to July 2018 at the Charité-Universitätsmedizin Berlin in Germany [11]. The investigators demonstrated comparable outcomes among older patients compared to their younger counterparts [11], confirming excellent outcomes, including in patient and graft survival, in carefully selected older kidney transplant recipients aged ≥ 75 years [29][30][31]. Lastly, in this Special Issue, we reported outcomes of kidney transplant recipients with sickle cell disease (SCD) from an analysis of the 2000-2019 United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network Database [14].…”

mentioning

confidence: 95%