Renal Transplantation in Elderly Patients Older Than 70 Years of Age: Results From the Scientific Registry of Transplant Recipients

Rao, Panduranga S.; Merion, Robert M.; Ashby, Valarie B.; Port, Friedrich K.; Wolfe, Robert A.; Kayler, Liise K.

doi:10.1097/01.tp.0000259621.56861.31

Cited by 415 publications

(360 citation statements)

References 22 publications

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“…The empirically estimated life expectancy of elderly patients might influence decision-making. Recent papers show that despite its higher early mortality rate, KTx provides a survival benefit in the elderly (46,47). Moreover, due to the aging of organ donors and the interest of so-called ''old for old'' programs (48), the influence of age on patient selection and organ allocation, especially in those with only a few comorbidities, should be revisited.…”

Section: Discussionmentioning

confidence: 99%

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Bayat

Macher

Couchoud

et al. 2015

American Journal of Transplantation

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Several studies have investigated geographical variations in access to renal transplant waiting lists, but none has assessed the impact on these variations of factors at both the patient and geographic levels. The objective of our study was to identify medical and nonmedical factors at both these levels associated with these geographical variations in waiting-list placement in France. We included all incident patients aged 18-80 years in 11 French regions who started dialysis between January 1, 2006, and December 31, 2008. Both a multilevel Cox model with shared frailty and a competing risks model were used for the analyses. At the patient level, old age, comorbidities, diabetic nephropathy, non-autonomous first dialysis, and female gender were the major determinants of a lower probability of being waitlisted. At the regional level, the only factor associated with this probability was an increase in the number of patients on the waiting list from 2005 to 2009. This finding supports a slight but significant impact of a regional organ shortage on waitlisting practices. Our findings demonstrate that patients' age has a major impact on waitlisting practices, even for patients with no comorbidity or disability, whose survival would likely be improved by transplantation compared with dialysis.

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Section: Discussionmentioning

confidence: 99%

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Bayat

Macher

Couchoud

et al. 2015

American Journal of Transplantation

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“…We restricted age to over 21 because access to transplantation among individuals who develop end stage renal disease in childhood may be confounded by parental health literacy. We restricted age to under 75 because transplant rates among those over 75 are very low (10). We restricted our study to those who had been receiving maintenance dialysis at least 9 mo as this is an agreed-upon time frame during which a patient can be expected to acclimate to dialysis and be referred for transplant evaluation (11).…”

Section: Study Setting Participants and Designmentioning

confidence: 99%

Health Literacy and Access to Kidney Transplantation

Grubbs

Gregorich

Pérez‐Stable

et al. 2009

Clinical Journal of the American Society of Nephrology

165

149

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Background and objectives: Few studies have examined health literacy in patients with end stage kidney disease. We hypothesized that inadequate health literacy in a hemodialysis population is common and is associated with poorer access to kidney transplant wait-lists.Design, setting, participants, & measurements: We enrolled 62 Black and White maintenance hemodialysis patients aged 18 to 75. We measured health literacy using the short form Test of Functional Health Literacy in Adults. Our primary outcomes were (1) time from dialysis start date to referral date for kidney transplant evaluation and (2) time from referral date to date placed on kidney transplant wait-list. We used Cox proportional hazard models to examine the association between health literacy (adequate versus inadequate) and our outcomes after controlling for demographics and co-morbid conditions.Results Conclusions: Inadequate health literacy is common in our hemodialysis patient population and is associated with a lower hazard of referral for transplant evaluation. Strategies to reduce the impact of health literacy on the kidney transplant process should be explored.

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“…For example, nephrology literature highlights similar themes with older adults facing decisions about dialysis and kidney transplantation. [51][52][53][54][55][56] The incidence of end stage renal disease is increasing more quickly among older adults than any other age group and is associated with a low QOL and high mortality. 51 Given this trend, nephrology practice guidelines were developed to promote patients' active participation in the decision-making process.…”

Section: Older Patients With Other Diseases: Decision Making In Nephrmentioning

confidence: 99%

Process of allogeneic hematopoietic cell transplantation decision making for older adults

Randall

Keven

Atlı

et al. 2015

Bone Marrow Transplant

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Allogeneic hematopoietic cell transplantation (alloHCT) may be the only curative option for some older adults with hematologic malignancies, and its associated risks of significant morbidity and mortality warrant a clear, informed decision-making process. As older adults have not been transplanted routinely until recent years, younger people have been the prototypical group around whom the current process has developed. Yet, this process is applied to older adults who have different considerations than younger patients when making their transplant decision. Older adults do not have the open-ended lives of younger patients and are entitled to consider how to spend their remaining time. They also possess maturity and experience, and with proper knowledge, they can make informed choices rather than moving forward in the transplant process unaware. Notably, older patients face similar problems with the informed decision-making process in nephrology. Strategies such as providing education about alloHCT gradually and repeatedly during induction, presenting recent knowledge from the literature in plain language, and utilizing a team approach to patient education may help older adults make the best decision about transplant in light of their situation and values. Understanding when and how older adults decide on alloHCT is an important first step to further exploring this problem.

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Renal Transplantation in Elderly Patients Older Than 70 Years of Age: Results From the Scientific Registry of Transplant Recipients

Abstract: Transplantation offers a significant reduction in mortality compared with dialysis in the wait-listed elderly population with end-stage renal disease.

Cited by 415 publications

References 22 publications

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Health Literacy and Access to Kidney Transplantation

Process of allogeneic hematopoietic cell transplantation decision making for older adults

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