Elsevier

Transplantation Proceedings

Volume 40, Issue 10, December 2008, Pages 3413-3417
Transplantation Proceedings

Renal transplantation
Outcome
Deceased Donor Kidney Transplantation in Elderly Patients: Is There a Difference in Outcomes?

https://doi.org/10.1016/j.transproceed.2008.08.127Get rights and content

Abstract

Introduction

There is a paucity of data on long-term outcomes of older kidney recipients. Our aim was to compare the early and long-term outcomes of deceased donor kidney transplantation in patients aged ≥60 years with outcomes in younger recipients.

Materials and Methods

From 1998 to 2005, we performed 271 deceased donor kidney transplants. There were 76 recepients (28.1%) >60 years old. Older candidates were carefully selected based on their physiologic, cardiac, and performance status. Demographic data, including clinical characteristics, early complications, mortality, and patient and graft survival rates, were collected and analyzed.

Results

Older patients had comparable perioperative mortality and morbidity, incidence of delayed graft function (DGF), length of stay, and readmissions compared with younger patients. The rates of acute rejection and major infections were also comparable between the 2 study groups. Among older recipients, 25/76 (32.1%) patients received extended criteria donor kidneys compared with only 35/195 (17.9%) of younger patients (P < .001). Nevertheless, equivalent 1-, 3-, and 5-year allograft survival rates were observed in elderly and young patients; 91.5% versus, 92.5%, 78.5% versus 81.9%, and 75.6% versus 78.5%, respectively. Overall patient survival was also comparable in both groups.

Conclusion

Kidney transplantation in appropriately selected elderly recipients provides equivalent outcomes compared with those observed in younger patients. These observations support the notion that older recipients should not lose access to deceased donor kidney transplantation in the effort to achieve a perceived gain in social utility.

Section snippets

Methods

We conducted a retrospective analysis of a prospectively collected database of all deceased donor (DD) kidney transplants performed in adult recipients at Massachusetts General Hospital from January 1, 1998, through December 31, 2005. The only exclusions were pediatric patients (<20 years of age), simultaneous kidney–pancreas transplantation, other multi-organ transplants (heart–kidney, liver–kidney), and living donor kidney allograft recipients. A total of 271 DD kidney transplants met the

Results

Of the 76 patients (28.1%) who were >60 years old, 25 (32.1%) received ECD, 14 DCD, and 37 SCD kidneys. Of 195 younger recipients, only 35 (17.9%) received ECD kidneys (P < .001).

Donor, recipient, and allograft characteristics are summarized in Table 1. Because there were more older recipients who received ECD allografts, donor age was higher in these patients and more donors had a history of hypertension. However, donor body mass index (BMI) donor terminal SCr levels, and cold ischemia times

Discussion

According to the US Census Bureau, Americans in the 65–84 years of age range constituted 10.9% of the population in 2000; by 2050, they are projected to make up 15.7%.5 The demographics of ESRD demonstrate a constant increase in the age of new patients starting renal replacement therapy every year.1 With the aging of the American population, further growth in the population of elderly patients with ESRD is clearly anticipated. Approximately 160,000 patients in the United States >65 years (and

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