The Vanishing Importance of Age in Renal Transplantation

Roodnat, Joke I.; Zietse, Robert; Mulder, Paul; Rischen-Vos, J.; Gelder, Teun van; IJzermans, Jan N.M.; Weimar, Willem

doi:10.1097/00007890-199902270-00015

Cited by 101 publications

(54 citation statements)

References 11 publications

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“…7,10 Our results are in accordance with these reports; more than 50% of graft losses in older individuals were due to death with a functioning kidney, and 71.4% from cardiovascular or malignant diseases.…”

Section: Discussionsupporting

confidence: 92%

“…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. 7,13 Consistent with these observations, we also found a significantly lower rejection rate among the older group, which may also contribute to the survival results.…”

Section: Discussionsupporting

confidence: 89%

“…[3][4][5] Several studies have reported that graft and patient survivals were lower among patients 60 years or older, when compared with recipients aged 18 to 59. 6,7 On the other hand, similar results between older and younger groups were observed for death censored graft survival and in both graft and patient survivals among the elderly with low-risk profiles. 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.…”

Section: Discussionsupporting

confidence: 71%

“…However, there is controversy regarding the outcomes with older kidneys. 7,15,16 Donor age was significantly higher in our older recipients. We analyzed the outcome of our elderly patients according to donor's age and failed to observe a significant difference in actuarial patient and graft survivals when comparing older recipients of kidneys from an aging donor.…”

Section: Discussionmentioning

confidence: 65%

See 3 more Smart Citations

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: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 65%

See 2 more Smart Citations

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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show abstract

“…A recent analysis of registry data indicated that transplant recipients 60-74 years old had better survival compared to similarly aged dialysis patients on the transplant waiting list (521). Although patient survival declines with increasing age, graft survival censored for death is better with increasing age (1019,1020). The net result is that there is similar overall graft survival for older compared to younger renal transplant recipients (1019,1020).…”

Section: Agementioning

confidence: 99%

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

2001

American Journal of Transplantation

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Substitutive Treatments of End-Stage Renal Diseases in the Elderly: Renal Transplantation

Alobaidli¹,

Jassal²

The Aging Kidney in Health and Disease

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The Vanishing Importance of Age in Renal Transplantation

Abstract: Considering the improving results over time, there are, at this moment, no arguments for an age restriction for kidney transplant recipients or donors.

Cited by 101 publications

References 11 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

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

Substitutive Treatments of End-Stage Renal Diseases in the Elderly: Renal Transplantation

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