Age disparities in transplantation

Abstract

Purpose of review The aim of this review is to outline disparities in liver and kidney transplantation across age spectrum. Disparities do not involve only recipients whose age may severely affect the possibility to access to a potentially life-saving procedure, but donors as well. The attitude of transplant centers to use older donors reflects on waiting list mortality and drop-out. This review examines which age categories are currently harmed and how different allocation systems may minimize disparities. Recent findings Specific age categories suffer disparities in the access to transplantation. A better understanding of how properly evaluate graft quality, a continuous re-evaluation of the most favorable donor-to-recipient match and most equitable allocation system are the three key points to promote ‘justice and equality’ among transplant recipients. Summary The duty to protect younger patients waiting for transplantation and the request of older patients to have access to potentially life-saving treatment urge the transplant community to use older organs thus increasing the number of available grafts, to evaluate new allocation systems with the aim to maximize ‘utility’ while respecting ‘equity’ and to avoid ‘futility’ thus minimizing waiting list mortality and drop-out, and improving the survival benefits for all patients requiring a transplant. Video abstract http://links.lww.com/COOT/A9

Impact of Work Status on Quality of Life in Patients with End-stage Renal Disease During the First Year of Hemodialysis

“…Factors such as nancial costs [6], organizational barriers [7], surgical risks [8], and other reasons [9,10] limit patient access to donor kidneys, therefore limiting this treatment modality to many patients. Continuous renal replacement therapy is the most common treatment available for chronic renal failure [11]. It is primarily a blood puri cation procedure and can replace the main renal functions, but it has some side effects, especially hemodialysis (HM) versus peritoneal dialysis (PD) [12], which may considerably worsen the patient's quality of life.…”

Downregulation of Swine Leukocyte Antigen Expression Decreases the Strength of Xenogeneic Immune Responses towards Renal Proximal Tubular Epithelial Cells

“…Thus, patients suffering from end-stage kidney disease rely on dialysis or highly desirable kidney transplantation as the most effective treatment option. However, both scarcity of organs and genetic disparities between donor and recipient, mainly based on human leukocyte antigen loci, often lead to long waiting times until kidney transplantation [ 2 , 3 , 4 , 5 ]. Currently, a mortality rate of 15% is observed in patients waiting on average 3.9 years for a suitable organ [ 6 ].…”

Tissue-specific cells generated to predict xenogeneic immune responses demonstrate that SLA-downregulated kidney proximal tubular epithelial cells are low immunogenic

“…Thus, patients suffering from end-stage kidney disease (ESRD) rely on dialysis or the highly desirable kidney transplantation (KTx) as the most effective treatment option. However, both scarcity of organs and genetic disparities between donor and recipient mainly on human leukocyte antigen loci often lead to long waiting times until KTx [2][3][4][5] . Currently, a mortality rate of 15% is observed in patients waiting on average 3.9 years for a suitable organ 6 .…”