Clinical outcomes of kidney transplantation in older end‐stage renal disease patients: A nationwide cohort study

Abstract

Aim The aim of the present study was to investigate the clinical outcomes of kidney transplantation (KT) in elderly recipients compared with those in young recipients. Methods We compared the incidence of biopsy‐proven acute rejection, death‐censored allograft survival and all‐cause mortality, and also compared the impact of high sensitization or desensitization on the clinical outcomes of elderly and young recipients. Results A total of 4966 KT recipients from the Korean Organ Transplantation Registry were included. The definition of elderly recipients was based on age >60 years (n = 356), and recipients aged <60 years were defined as young recipients (n = 4610). The incidence of biopsy‐proven acute rejection did not differ between the two groups irrespective of the donor type; however, the impact of high sensitization was significant only in young recipients. Being an elderly recipient was an independent risk factor for death‐censored allograft failure in terms of overall and living donor KT, but not with deceased donor KT. In regard to patient death, being an elderly recipient was a significant predictor in general and in the two subgroups, and desensitization showed a significant interaction with death in the elderly recipients in the living donor KT group. Conclusions In conclusion, KT in elderly recipients might be associated with poor allograft or patient survival in general, and especially, desensitization therapy carried out in these patients might increase the risk of patient mortality. Geriatr Gerontol Int 2019; 19: 392–398.

Early outcomes and long-term survival after kidney transplantation in elderly versus younger recipients from the same donor in a matched-pairs analysis

“…In our study long-term patient and graft survival were significantly worse in the elderly group, but death-censored graft survival did not differ in the elderly, which indicates that most of the EKT deaths occurred while the recipient still had the functioning graft. The same observation was done in other studies, there was no difference in death censored allograft survival in patients following deceased donor kidney transplantation aged >60 and <60 years [17] …”

“…The same observation was done in other studies, there was no difference in death censored allograft survival in patients following deceased donor kidney transplantation aged >60 and <60 years. [17] The elderly population is underrepresented in published studies, and we believe that our unique methodological approach may at least modestly contribute to filling the existing gaps in knowledge.…”

“…The same observation was done in other studies, there was no difference in death censored allograft survival in patients following deceased donor kidney transplantation aged >60 and <60 years. [ 17 ]…”

Kidney transplantation in highly sensitized recipients

“…Until now, most studies on the risk of desensitization treatment have been short-term studies; hence, the impact of the longterm risk of desensitization treatment remains unclear. Inconsistent results have been reported on the effect of desensitization treatment on infection risk [91][92][93][94]. Kahwaji et al [93] reported that there were no differences in bacterial, viral, and fungal infection rates between the rituximab with high-dose IVIG group and the non-administered group over 18 months after transplantation.…”

Care Needs for Organ Transplant Recipients Scale: Development and psychometric testing

“…Care needs of renal transplant recipients are influenced by their demographic data (e.g., sex and age) and specific disease characteristics (Costa‐Requena et al, 2017a; Ko et al, 2019). Recipients are eager to receive disease‐specific care and instructions because their needs vary based on side effects and adherence with immunosuppressive medication (Been‐Dahmen et al, 2018; Leite et al, 2018; Luk, 2004), living or deceased donor (Ko et al, 2019; Zimmermann, Pabst, Bertram, Schiffer, & de Zwaan, 2016), time since transplantation (Antunes et al, 2018; Been‐Dahmen et al, 2018), complications or organ rejection occurrence and recurrence of the primary disease (Bicalho et al, 2019). The high unmet needs were significantly associated with decreased quality of life, self‐reported health status and increased symptom burden (Ko, 2016), anxiety (Chen, Weng, & Lee, 2010) and depression (Park, Park, Oh, & Cho, 2017).…”