Patient and Graft Survival in Older Kidney Transplant Recipients

Fabrizii, Veronika; Winkelmayer, Wolfgang C.; Klauser, R; Kletzmayr, Josef; Saemann, M.; Steininger, R.; Kramar, Reinhard; Hörl, Walter H.; Kovařík, Josef

doi:10.1097/01.asn.0000120370.35927.40

Cited by 95 publications

(77 citation statements)

References 43 publications

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“…6 In a study comparing the survival rates of recipients older than 65 years to those aged between 60 to 64 or 50 to 59 years, after adjusting for confounders, the authors did not find significant differences for 5-year graft survival by age group. 8 Other investigators found similar 5-year graft survivals between the oldest patients (Ͼ60 years) and the youngest group (20 -29 years). 9 Another group found that 5-year graft survivals were even superior in older recipients when compared with the younger group (90% vs. 82%).…”

Section: Discussionmentioning

confidence: 77%

“…In a recent study the older patients without these risk factors had patient and graft survival equivalent to younger recipients. 6,8 Careful selection of older candidates along with a complete assessment of cardiac and infectious risk as well as tailored immunosuppression may improve survival in elderly patients. 12 Some authors have argued that the better results reported in some series of older recipients may be due to less acute rejection in elderly recipients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Pedroso

Martins

Fonseca

et al. 2006

Transplantation Proceedings

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The prevalence of end-stage renal disease (ESRD) increases with advancing age. In most countries renal transplant recipients are getting older, too. Transplantation must be considered for ESRD patients older than 60 years; however, there are few data regarding outcomes in this population. We retrospectively reviewed the clinical course of recipients aged Ն60 years (n ϭ 43) who underwent primary or repeated grafts from August 1988 to December 2004. We then compared recipient and donor characteristics as well as graft and patient survivals with recipients aged 18 to 59 years (n ϭ 1058) who were transplanted during the same time. Donor age tended to be higher among the oldest recipient group (P Ͻ .001). Mean follow-up was significantly shorter in the group aged Ն60 years (P Ͻ .001), as our institution only recently has frequently accepted patients Ն60 years. Older recipients showed more frequent delayed graft function (P ϭ .007), longer initial hospitalization (P ϭ .005), and a significantly lower incidence of posttransplant acute rejection episodes (P ϭ .015). Patient (P ϭ .057), graft (P ϭ .407), and death-censored graft (P ϭ .649) survivals were not different between the two groups. Seven recipients aged Ն60 years died; the main cause of which was cardiovascular in origin. The loss of organs (n ϭ 11) in the older patients was mainly due to death with a functioning kidney (54.5%). Our results confirm that renal transplant must be considered in selected patients older than 60 years as patient and graft survivals are similar to those of younger patients. E LDERLY PATIENTS are the fastest growing population in dialysis programs. 1 Hemodialysis is the more commonly used modality, although it is associated with significant morbidity, mortality, and a poor quality of life. The prevalence of end-stage renal disease (ESRD) increases with advancing age. In most countries, renal transplant recipients are also getting older. In the precyclosporine era the unsatisfactory results of grafting in the elderly lead to the exclusion of patients more than 60 years of age due to higher risks for patient death and graft loss. 2 With widespread use of calcineurin inhibitors, the age limit for transplantation has expanded. Today, transplantation is considered the best treatment option for ESRD patients regardless of age when compared with dialysis. [3][4][5] With the development of new immunosuppressive alternatives, transplantation is safe and successful. It should be considered an alternative to dialysis even among older patients. Older ESRD patient survival after transplantation is higher than on the waiting list. [3][4][5] However, the organ donor shortage makes clinicians reluctant to transplant kidneys into older patients. Controversy has emerged regarding the appropriateness of transplantation in this patient group with a shortened life expectancy. Numerous studies have reported worse patient and graft survivals in older patients compared with younger patients, while other analyses did not find any difference. 6 -9 The...

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Pedroso

Martins

Fonseca

et al. 2006

Transplantation Proceedings

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“…Older recipients have lower rates of acute rejection but are at higher risk for the complications of over-immunosuppression, such as infections and malignancies (24). When patients are carefully selected and immunosuppressive treatment is applied reasonably, then renal transplantation for older people can be useful, and higher graft survival rates can be obtained (22,25). It has been observed that, in addition to recommendations by health care personnel, persons of advanced age do not prefer to have KT due to their age (6).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Knowledge About and Attitudes Towards Kidney Transplantation in Patients Undergoing Hemodialysis Treatment

Kalender¹,

Tosun²,

Bağçıvan³

et al. 2015

Turk Neph Dial Transpl

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OBJECTIVE:The aim of the present study was to evaluate hemodialysis (HD) patients' knowledge about and attitudes towards Kidney Transplantation (KT). MATERIAL and METHODS:A total of 104 HD patients from two HD centers in a large city in central Turkey were included in this descriptive study. The questionnaire that was developed by researchers included questions on sociodemographic data and dialysis vintage, level of satisfaction resulting from HD treatment, willingness to undergo KT, knowledge about KT and choice of donor, etc. RESULTS:The mean age of the 104 patients was 60.03±17.01 years and the mean of dialysis vintage was 4.53±3.04 years. Of these patients, 62.5% declared their willingness to undergo KT, and among these, 76.9% declared that they had knowledge about KT. In regard to choice of donor, 79.7% stated that it was not important, while 56.7% were not informed about the existence of a waiting list for cadaveric donors. CONCLUSION:In order to increase in our country the number of cadaveric donors, which represent the most appropriate source of organ donation, several strategies should be considered, such as awareness-raising activities for patients and the community through campaigns by both the public and private sectors, and mass media. KEY WORDS:Attitude, Kidney transplantation, Knowledge ÖZ AMAÇ: Çalışmada, hemodiyaliz (HD) hastalarının böbrek nakli hakkındaki bilgi ve tutumları değerlendirilmektedir. GEREÇ ve YÖNTEMLER:Tanımlayıcı tipteki bu çalışma, Türkiye'nin büyük bir kentinde iki HD merkezinde, araştırmaya katılmayı kabul eden 104 HD hastası ile yürütülmüştür. Veriler, hastaların sosyodemografik verileri ve diyaliz süresi, HD tedavisinden memnuniyet durumları, böbrek nakli için gönüllü olma, böbrek nakli ve donör seçimi hakkında bilgi durumu gibi soruların yer aldığı ve araştırmacılar tarafından geliştirilen anket formu ile toplanmıştır. BULGULAR:Hastaların yaş ortalamaları 60,03±17,01 ve ortalama diyaliz süresi 4,53±3,04 yıldır. Hastaların %76,9'u nakil hakkında bilgi sahibi olduğunu belirtirken, %62,5'i böbrek nakli olmak istediklerini ifade etmiştir. Nakil olmak isteyen hastalardan %79,7'si için donör tipi önemli değildi. Hastaların %56,7'si gibi önemli bir oranı ise kadavra bekleme listesindeki mevcut durumu hakkında bilgisi olmadığını belirtmiştir. SONUÇ:Ülkemizde böbrek nakli sayısının artırılması için en uygun donör olan kadavra vericilerinin sayısının arttırılması amacıyla gerek devlet gerekse özel hizmet veren tüm kuruluşlar tarafından kampanyaların düzenlenmesi, internet siteleri ve medya aracılığıyla hastaların ve toplumun bilinçlendirilmesi gereklidir.

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“…It is likely that most people would choose the younger patient, based on reasons of future productivity and better utility for the community, and most protocols for transplantation actually exclude patients older than 65 years, but recent studies have shown good results in transplanted patients over this age. 19 So do we have any right to value the life of one person more than another based on years already lived? Let us take a look at another scenario of a patient with end-stage renal disease secondary to human immunodeficiency virus (HIV)-associated nephropathy and another with diabetic nephropathy being considered for the same donated kidney.…”

Section: Fairness and Equitymentioning

confidence: 99%

Ethical issues in kidney transplantation – reflections from Nigeria

Fadare¹,

Salako²

2010

TRRM

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Abstract:Organ transplantation has become a life-saving procedure for many disease conditions hitherto considered incurable. Kidney transplantation, now the treatment of choice for end-stage renal disease, is the commonest solid organ transplantation carried out in the world at the moment and it is the only solid organ transplantation done in Nigeria. This procedure, in addition to prolonging lives, also provides better quality of life and is evaluated as cost-effective, because it makes more resources available to other sectors of the economy. Organ transplantation in general and kidney transplantation in particular are fraught with ethical issues and dilemmas worldwide. Some of the ethical issues arising in the setting of developing countries like Nigeria may differ from those in countries where this procedure is established. Informed consent of the donor and the recipient is a major requirement for both organ donation and transplantation. Regarding donation, the ethical issues may differ depending on the type of organ donation, ie, whether it is living-related, living-unrelated, cadaveric, or from brain-dead individuals. Commodification of organs is identified as an ethical dilemma, and arguments for and against this practice are put forward here. Confidentiality of donor information, fairness and equity in donor selection, and access to kidney transplantation when needed are also discussed. Finally, the issue of safety of organ harvesting for the donor and of the transplantation process itself, and the possible long-term consequences for both parties are investigated.

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Patient and Graft Survival in Older Kidney Transplant Recipients

Cited by 95 publications

References 43 publications

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Evaluation of Knowledge About and Attitudes Towards Kidney Transplantation in Patients Undergoing Hemodialysis Treatment

Ethical issues in kidney transplantation – reflections from Nigeria

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Patient and Graft Survival in Older Kidney Transplant Recipients

Cited by 95 publications

References 43 publications

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Renal Transplantation in Patients Over 60 Years of Age: A Single-Center Experience

Evaluation of Knowledge About and Attitudes Towards Kidney ￼Transplantation in Patients Undergoing Hemodialysis Treatment

Ethical issues in kidney transplantation &ndash; reflections from Nigeria

Contact Info

Product

Resources

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Evaluation of Knowledge About and Attitudes Towards Kidney Transplantation in Patients Undergoing Hemodialysis Treatment

Ethical issues in kidney transplantation – reflections from Nigeria