Kidney Transplantation in Old Recipients From Old Donors: A Single-Center Experience

Nikodimopoulou, M.; Karakasi, Konstantina-Eleni; Daoudaki, M.; Fouza, A.; Vagiotas, L.; Myserlis, G.; Antoniadis, Nikolaos; Salveridis, Nikolaos; Fouzas, I.

doi:10.1016/j.transproceed.2019.01.019

Cited by 9 publications

(5 citation statements)

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“…Brazilian population, as in other countries, is in the process of aging, and this phenomenon is irreversible [ 8 , 47 ]. Efforts should be made to increase the frequency of KT in this population, and in this sense, our results corroborates others [ 48 ] and demonstrated that it is possible to transplant elderly people without damage.…”

Section: Discussionsupporting

confidence: 91%

Logistic Regression Model in a Machine Learning Application to Predict Elderly Kidney Transplant Recipients with Worse Renal Function One Year after Kidney Transplant: Elderly KTbot

Júnior

Couto²,

Pereira

et al. 2020

Journal of Aging Research

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Background. Renal replacement therapy (RRT) is a public health problem worldwide. Kidney transplantation (KT) is the best treatment for elderly patients’ longevity and quality of life. Objectives. The primary endpoint was to compare elderly versus younger KT recipients by analyzing the risk covariables involved in worsening renal function, proteinuria, graft loss, and death one year after KT. The secondary endpoint was to create a robot based on logistic regression capable of predicting the likelihood that elderly recipients will develop worse renal function one year after KT. Method. Unicentric retrospective analysis of a cohort was performed with individuals aged ≥60 and <60 years old. We analysed medical records of KT recipients from January to December 2017, with a follow-up time of one year after KT. We used multivariable logistic regression to estimate odds ratios for elderly vs younger recipients, controlled for demographic, clinical, laboratory, data pre- and post-KT, and death. Results. 18 elderly and 100 younger KT recipients were included. Pretransplant immune variables were similar between two groups. No significant differences (P>0.05) between groups were observed after KT on laboratory data means and for the prevalences of diabetes mellitus, hypertension, acute rejection, cytomegalovirus, polyomavirus, and urinary infections. One year after KT, the creatinine clearance was higher (P = 0.006) in youngers (70.9 ± 25.2 mL/min/1.73 m2) versus elderlies (53.3 ± 21.1 mL/min/1.73 m2). There was no difference in death outcome comparison. Multivariable analysis among covariables predisposing chronic kidney disease epidemiology collaboration (CKD-EPI) equation <60 mL/min/1.73 m2 presented a statistical significance for age ≥60 years (P = 0.01) and reduction in serum haemoglobin (P = 0.03). The model presented goodness-fit in the evaluation of artificial intelligence metrics (precision: 90%; sensitivity: 71%; and F1 score: 0.79). Conclusion. Renal function in elderly KT recipients was lower than in younger KT recipients. However, patients aged ≥60 years maintained enough renal function to remain off dialysis. Moreover, a learning machine application built a robot (Elderly KTbot) to predict in the elderly populations the likelihood of worse renal function one year after KT.

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Section: Discussionsupporting

confidence: 91%

Logistic Regression Model in a Machine Learning Application to Predict Elderly Kidney Transplant Recipients with Worse Renal Function One Year after Kidney Transplant: Elderly KTbot

Júnior

Couto²,

Pereira

et al. 2020

Journal of Aging Research

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“…Фактором, потенциально влияющим на результаты трансплантации почки у реципиентов старшей возрастной группы, является наличие множества сопутствующих заболеваний, ограничивающих возможности трансплантации [9,10]. Их прогрессирование часто ведет к смерти реципиентов при нормально функционирующем почечном трансплантате [10][11][12].…”

Section: опыт практической трансплантологии Experience In Practical T...unclassified

Results of kidney transplantation from suboptimal donors to recipients of the older age group

Khubutiya¹,

Khubutiya²,

Евсеев³

et al. 2022

Transplantologiâ (Mosk.)

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Introduction. Among the growing number of patients with chronic renal failure who need dialysis therapy or kidney transplantation, a significant proportion are people over 60 years old, making from 30 to 45% of all patients who need dialysis, according to various sources. The elderly age of the recipient contributes to the risk of developing graft dysfunction due to the presence of concomitant diseases that worsen the immediate and long-term results of transplantation. And the probability of receiving a kidney graft in elderly patients is significantly lower than in young recipients. One of the ways to solve this problem is to use kidneys from suboptimal donors.Material and methods. The analysis of clinical examinations, laboratory and instrumental test results obtained in 124 patients who underwent cadaveric kidney allotransplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine, including that from suboptimal donors, was carried out. Of these, 69 (55.6%) recipients aged 60 years and older were included in the main group (group 1), and 55 recipients younger than 60 years (44.4%) in the comparison group (group 2).Results. Kidney transplantation to elderly patients (aged 60 years and older), including from a suboptimal donor, provides a sufficiently high efficiency with a 1-year recipient survival rate of 98.6% and a functioning graft for 1 year in 75.4% of cases, which does not differ from the survival rate of younger recipients (98.2%), but is inferior by the case rate of keeping the graft functioning (91.9%). Meanwhile, the parameters characterizing the functional state of the transplanted organs that maintained their function for 1 year did not differ statistically significantly between elderly and younger recipients.Conclusions. The results of the study showed that kidney transplantation from suboptimal donors to patients of the older age group provides acceptable results with low mortality of recipients and a 1-year functioning of the graft in 75% of cases. This makes it possible to increase the availability of kidney transplantation for patients of the older age group and achieve better survival results, provided adequate selection of recipients and an objective assessment of the quality of transplanted organs.

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“…С учетом мировой тенденции старения населения и возрастания частоты развития ХПН у пожилых больных в 1999 г. разработана Европейская программа (ESP) по пересадке почки от пожилых доноров (старше 65 лет) пожилым реципиентам (старше 65 лет) (схема "оld-to-old"), с целью уменьшения сроков ожидания трансплантата пожилыми больными, сокращения сроков холодовой ишемии трансплантата и повышения доступности трансплантации [17], применение которой позволило существенно увеличить доступность и сроки ожидания трансплантата для пожилых пациентов [15,18]. В первые годы реализации программы "oldto-old" результаты трансплантаций существенно уступали эффективности пересадок почки от оптимальных доноров более молодым реципиентам.…”

Section: трансплантация почки по системе "Old-to-old"unclassified

“…При пересадке почек от старых доноров пожилым реципиентам результаты трансплантации были такими же, как и при трансплантации от более молодых доноров, что позволяет считать приемлемым такой вариант пересадки [34] В то же время ряд авторов приводят данные о более благоприятных результатах трансплантации почек пожилым реципиентам от молодых доноров по сравнению со старыми донорами. M. Nikodimopoulou et al [18] сообщают о менее благоприятных результатах трансплантации почки при варианте "old-to-old" (донор и реципиент старше 65 лет) по сравнению с вариантом "old-to-young" (реципиент моложе 65 лет): 5-летнее функционирование трансплантатов составило 50% и 72% соответственно, а выживаемость реципиентов -58% и 80% соответственно. A.I.…”

Section: трансплантация почки по системе "Old-to-old"unclassified

Current possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological history

Khubutiya¹,

Rzhevskaya²,

Лисенок³

2021

Transplantologiâ (Mosk.)

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Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.

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Kidney Transplantation in Old Recipients From Old Donors: A Single-Center Experience

Cited by 9 publications

References 10 publications

Logistic Regression Model in a Machine Learning Application to Predict Elderly Kidney Transplant Recipients with Worse Renal Function One Year after Kidney Transplant: Elderly KTbot

Logistic Regression Model in a Machine Learning Application to Predict Elderly Kidney Transplant Recipients with Worse Renal Function One Year after Kidney Transplant: Elderly KTbot

Results of kidney transplantation from suboptimal donors to recipients of the older age group

Current possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological history

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