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Are Octogenarians With End-Stage Renal Disease Candidates for Renal Transplantation?

View Article: PubMed Central - PubMed

ABSTRACT

Background: Elderly patients are the fastest-growing group in need of renal transplantation. This study puts focus on renal transplant recipients in their 80th year or longer at time of engraftment. Is there evidence to support an absolute upper age limit for renal transplantation?

Methods: Recipients in their 80th year or longer, transplanted between 1983 and 2015, were included. Data were retrieved from the Norwegian Renal Registry in the end of October 2015. Graft and patient survivals were compared with recipients aged 70 to 79 years at transplantation.

Results: Forty-seven patients older than 79 years were transplanted in the defined period. Median age 80.1 years, 81% were men. Median time on dialysis before transplantation was 18.5 months. All patients received an allograft from a deceased donor (median donor age, 61.8 years). In the death-censored graft survival model, there was no statistical difference between the groups. We found improved patient and graft survivals after introduction of mycophenolate mofetil and induction with basiliximab. Patients transplanted before 2000 had increased risk of death compared with those transplanted after 2000 (hazard ratio, 3.2; 95% confidence interval, 1.2-8.7). Median uncensored graft survival for patients transplanted after the year 2000 was 5.0 year (95% confidence interval, 2.4-7.6). Median patient survival was 5.0 years (3.1-6.9) and 5-year patient survival was 55%.

Conclusions: Age by itself should not be an absolute contraindication against renal transplantation. An estimated 5-year survival rate of 55% post-engraftment for an 80-year-old patient is in our opinion more than acceptable.

No MeSH data available.


Death-censored graft survival.
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Figure 2: Death-censored graft survival.

Mentions: We included data from 47 patients older than 79 years whom were transplanted at our center between January 1, 1983, and October 1, 2015. During this time span, 129 patients (74.9% men) aged 79 years or older entering renal replacement therapy have been reported by their treating nephrologists, as potential candidates for renal transplantation. Among these 129 patients, 53 (41%) passed the medical screening and were put on the kidney waiting list and 47 (89%) have received a transplant (Figure 1). Median age at transplantation was 80.1 years (79.1-83.6 years). Patient and transplant characteristics are presented in Table 1. All octogenarians received an allograft from a deceased donor. In the death-censored graft survival model, there was no statistical difference between the groups (Figure 2). Median uncensored graft survival was 4.1 years (95% confidence interval [95% CI], 1.7-6.5) in octogenarians and 6.4 years (6.0-6.8 years) in 70 to 79 years. Median patient survival was 4.7 years (2.8-6.6 years) in octogenarians compared with 6.5 years (6.1-6.9 years) (log rank, P < 0.001; Figure 3). Two- and five-year patient survival rates were 78% and 47% in octogenarians versus 85% and 67% in 70 to 79 years. Patients transplanted before 2000 had increased risk of death compared with patients transplanted after 2000 (hazard ratio, 3.2; 95% CI, 1.2-8.7). Recipient age, recipient sex, donor age, and time on dialysis were tested in the same model without any significant association to patient survival. A separate Kaplan-Meier analysis revealed a median patient survival of 2.5 years (0.0-5.5 years) for octogenarians transplanted before 2000 (n = 12) versus 5.0 years (3.1-6.9 years; P = 0.028) for those transplanted after 2000.


Are Octogenarians With End-Stage Renal Disease Candidates for Renal Transplantation?
Death-censored graft survival.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120766&req=5

Figure 2: Death-censored graft survival.
Mentions: We included data from 47 patients older than 79 years whom were transplanted at our center between January 1, 1983, and October 1, 2015. During this time span, 129 patients (74.9% men) aged 79 years or older entering renal replacement therapy have been reported by their treating nephrologists, as potential candidates for renal transplantation. Among these 129 patients, 53 (41%) passed the medical screening and were put on the kidney waiting list and 47 (89%) have received a transplant (Figure 1). Median age at transplantation was 80.1 years (79.1-83.6 years). Patient and transplant characteristics are presented in Table 1. All octogenarians received an allograft from a deceased donor. In the death-censored graft survival model, there was no statistical difference between the groups (Figure 2). Median uncensored graft survival was 4.1 years (95% confidence interval [95% CI], 1.7-6.5) in octogenarians and 6.4 years (6.0-6.8 years) in 70 to 79 years. Median patient survival was 4.7 years (2.8-6.6 years) in octogenarians compared with 6.5 years (6.1-6.9 years) (log rank, P < 0.001; Figure 3). Two- and five-year patient survival rates were 78% and 47% in octogenarians versus 85% and 67% in 70 to 79 years. Patients transplanted before 2000 had increased risk of death compared with patients transplanted after 2000 (hazard ratio, 3.2; 95% CI, 1.2-8.7). Recipient age, recipient sex, donor age, and time on dialysis were tested in the same model without any significant association to patient survival. A separate Kaplan-Meier analysis revealed a median patient survival of 2.5 years (0.0-5.5 years) for octogenarians transplanted before 2000 (n = 12) versus 5.0 years (3.1-6.9 years; P = 0.028) for those transplanted after 2000.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Elderly patients are the fastest-growing group in need of renal transplantation. This study puts focus on renal transplant recipients in their 80th year or longer at time of engraftment. Is there evidence to support an absolute upper age limit for renal transplantation?

Methods: Recipients in their 80th year or longer, transplanted between 1983 and 2015, were included. Data were retrieved from the Norwegian Renal Registry in the end of October 2015. Graft and patient survivals were compared with recipients aged 70 to 79 years at transplantation.

Results: Forty-seven patients older than 79 years were transplanted in the defined period. Median age 80.1 years, 81% were men. Median time on dialysis before transplantation was 18.5 months. All patients received an allograft from a deceased donor (median donor age, 61.8 years). In the death-censored graft survival model, there was no statistical difference between the groups. We found improved patient and graft survivals after introduction of mycophenolate mofetil and induction with basiliximab. Patients transplanted before 2000 had increased risk of death compared with those transplanted after 2000 (hazard ratio, 3.2; 95% confidence interval, 1.2-8.7). Median uncensored graft survival for patients transplanted after the year 2000 was 5.0 year (95% confidence interval, 2.4-7.6). Median patient survival was 5.0 years (3.1-6.9) and 5-year patient survival was 55%.

Conclusions: Age by itself should not be an absolute contraindication against renal transplantation. An estimated 5-year survival rate of 55% post-engraftment for an 80-year-old patient is in our opinion more than acceptable.

No MeSH data available.