Clinical Outcomes in Elderly Kidney Transplant Recipients are Related to Acute Rejection Episodes Rather Than Pretransplant Comorbidity

Heldal, Kristian; Hartmann, Anders; Leivestad, Torbjørn; Svendsen, Martin Veel; Foss, Aksel; Lien, B.; Midtvedt, Karsten

doi:10.1097/tp.0b013e31819cdddd

Cited by 99 publications

(100 citation statements)

References 25 publications

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“…The cohort age cutoff of Ն60 years was chosen in this study because this is consistent with prior reports (11)(12)(13)(14) and allowed sufficient power for multivariate analyses in each strata. To account for the age range in this elderly cohort, recipient age was stratified and included in each multivariate model.…”

Section: Methodsmentioning

confidence: 67%

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Gill¹,

Sampaio²,

Gill³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The choice of induction agent in the elderly kidney transplant recipient is unclear. Results In high-risk recipients with high-risk donors there was a higher risk of rejection and functional graft loss with IL2RA versus rATG. Among low-risk recipients with low-risk donors there was no difference in outcomes between IL2RA and rATG. In the two groups in which donor or recipient was high risk, there was a higher risk of rejection but not functional graft loss with IL2RA. Among low-risk recipients with high-risk donors, there was a trend toward a higher risk of death with IL2RA.Conclusions rATG may be preferable in high-risk recipients with high-risk donors and possibly low-risk recipients with high-risk donors. In the remaining groups, although rATG is associated with a lower risk of acute rejection, long-term outcomes do not appear to differ. Prospective comparison of these agents in an elderly cohort is warranted to compare the efficacy and adverse consequences of these agents to refine the use of induction immunosuppressive therapy in the elderly population.

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Section: Methodsmentioning

confidence: 67%

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Gill¹,

Sampaio²,

Gill³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Transplant outcomes improve with less dialysis time (71,72). In a Norwegian study, the worst outcomes were for patients older than age 70 with more than 1 year of dialysis (71). Survival was decreased for patients age 60-69 years with more than 1 year of dialysis, equivalent to the rate in patients older than age 70 with less than 1 year of dialysis (71).…”

Section: Transplantationmentioning

confidence: 99%

“…In a Norwegian study, the worst outcomes were for patients older than age 70 with more than 1 year of dialysis (71). Survival was decreased for patients age 60-69 years with more than 1 year of dialysis, equivalent to the rate in patients older than age 70 with less than 1 year of dialysis (71). Unfortunately, patients older than age 65 are less likely to receive a deceased-donor kidney within 1 year (73).…”

Section: Transplantationmentioning

confidence: 99%

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Renal Replacement Therapy in the Elderly Population

Berger¹,

Hedayati

2012

Clinical Journal of the American Society of Nephrology

100

101

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Summary ESRD has become an important problem for elderly patients. The segment of the ESRD population age 65 years or older has grown considerably, and this growth is expected to accelerate in coming years. Nephrologists caring for the elderly with advanced kidney disease will encounter patients with comorbid conditions common in younger patients, as well as physical, psychological, and social challenges that occur with increased frequency in the aging population. These challenging factors must be addressed to help inform decisions regarding the option to initiate dialysis, the choice of dialysis modality, whether to pursue kidney transplantation, and end-of-life care. This article will highlight some common problems encountered by elderly patients with ESRD and review data on the clinical outcomes of elderly patients treated with different modalities of dialysis, outcomes of kidney transplantation in the elderly, and nondialytic management of CKD stage 5.

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“…Some studies have attempted to identify factors that would predict outcomes in elderly kidney transplanted recipients. Most recently, Heldal et al [47] found that acute rejection in the first 90 days, and donor age C60 years predicted lower patient survival; whereas delayed graft function, donors aged 60 years or older, and HLA antibodies were associated with increased death-censored graft loss. Gill et al [48] …”

mentioning

confidence: 99%