Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy

Abstract

Our objectives were to evaluate kidney transplantation survival benefit in people aged ≥70 who were receiving renal replacement therapy (RRT) and to identify their risk factors for posttransplant mortality. This study included all patients in the national French Renal Epidemiology and Information Network registry who started RRT between 2002 and 2013 at age ≥70. Mortality risk was compared between patients with transplants; on the waiting list; and on dialysis matched for age, gender, comorbidities, and time on dialysis. Of the 41 716 elderly patients starting RRT, 1219 (2.9%) were on the waiting list and 877 (2.1%) underwent transplantation during the follow-up. Until month 3, transplant patients had a risk of death triple that of the wait-listed group. Although the risk was halved at month 9, the perioperative risk was still not offset by month 36. Compared with matched dialysis patients (n = 2183), transplant patients were not at significantly increased perioperative risk and had a lower mortality risk starting at month 3. Risk factors for posttransplant mortality were diabetes, cardiovascular comorbidities, and dialysis duration >2 years. Among older dialysis patients, 20% had neither cardiovascular comorbidity nor diabetes. Systematic early assessment of the eligibility of elderly patients for kidney transplantation is recommended to expand registration to patients with poor survival on dialysis and no cardiovascular comorbidity.

2017 Annual Report Digest of the Renal Epidemiology Information Network (REIN) registry

“…Compared to other countries, pre‐emptive kidney transplantation remains low, even if it is increasing steadily. However, the benefit of such strategy is still in debate from a national point of view especially with regard to the consequential increase in the waiting list .…”

“…Transplant teams are already developing a geriatric‐kidney transplantation activity and are using new tools for this population to develop access to kidney transplantation . The benefit of kidney transplantation in elderly patients remains debated and further studies are needed to better identify good candidates for transplantation and to improve models of care and patient satisfaction . Additionally, availability of kidney transplants is also a limiting factor to develop kidney transplantation in elderly patients.…”

Solid Organ Transplantation in Older Adults. Infectious and Other Age-Related Considerations

“…Age itself is an independent risk factor for postoperative morbidity and mortality [32][33][34][35][36][37][38][39]. The fact that transplant surgery is often long, involves patients with several comorbidities, often results in high volume transfusions in certain cases, especially increases the perioperative infection risk [33,40]. But even taking this into account, after about 3 months there is a survival benefit from transplant over dialysis in patients with end-stage-renal-disease [33,41].…”

Transplanting the Elderly: Mandatory Age- and Minimal Histocompatibility Matching

“…The majority of older transplant candidates are likely to die while on the waiting list before they get a transplant offer according to the Dutch Renine data. Mortality early after transplantation is also higher in elderly with a large French registry study reporting a 3-fold higher mortality risk in the first 3 postoperative months as compared to waitlisted counterparts (8).…”