2071 THE EVOLVING OUTCOMES OF KIDNEY TRANSPLANT RECIPIENTS OVER 70 YEARS OF AGE

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery I1 Apr 20102071 THE EVOLVING OUTCOMES OF KIDNEY TRANSPLANT RECIPIENTS OVER 70 YEARS OF AGE Islam Ghoneim, Ho Yee Tiong, Jesse Schold, Titte Srinivas, Charles Modlin, and Stuart Flechner Islam GhoneimIslam Ghoneim More articles by this author , Ho Yee TiongHo Yee Tiong More articles by this author , Jesse ScholdJesse Schold More articles by this author , Titte SrinivasTitte Srinivas More articles by this author , Charles ModlinCharles Modlin More articles by this author , and Stuart FlechnerStuart Flechner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior to 2000 only 2 patients over age 70 years had received a kidney transplant at our center. This age limit restriction was based anecdotal reports of excess morbidity and mortality for this group. Since 2000, we have transplanted 47 such patients, representing about 3.5% of our recipients, up to 6.3% the past 2 years. The annual mortality of such patients on dialysis exceeds 20%. Nationally, the proportion of patients > 70 in the past three years is 6% (an increase from 2.7% in the prior decade). The 1, 3, and 5 yr overall and death censored graft loss rates are (87, 75, 66) and (94, 90, 88). METHODS The Cleveland Clinic Unified Transplant Database was queried for all kidney-only transplant recipients age 70 years or older at transplant. There were 49 patients with a mean age of 72.5 (range 70-86) years including 34 males and 15 females. The cause of ESRD included GN 33%; HTN 22%; DM 12%, PKD 6%, Unknown 15%. The Donor Source included DD 67%; LRD 22%: and LUR 10%. The mean BMI was 27 kg/m2. Immunosuppression included mycophenolate mofetil and steroids with a CNI drug in 53.1% or an mTOR in 38.7% of cases. RESULTS The mean follow-up is 37.7 (range 1-92) months. K-M survivals (%) at 1,3, 5 years, respectively are for Patient Survival (86, 72, and 56). For Graft Survival -uncensored (86, 72, 56) vs. Graft-death censored (97, 94, 88).. Among 14 deaths the causes were CV 50%; Infectious 14%; Pulmonary 14%; and Unknown (out of hospital) 21%. One year biopsy confirmed acute rejection was 6%, and the mean creatinine was 1.25 mg/dL. There were 3 cases (6.1%) of de novo skin or solid organ cancers. CONCLUSIONS Patients over age 70 are seeking the option of kidney transplantation in greater numbers today. Their transplant outcomes are primarily driven by an increased rate of cardiovascular mortality the first 3 years. They exhibit relatively low rates of rejection, infection, and have excellent post transplant renal function. Pretransplant functional capacity and CV status are the best predictors of outcome. Cleveland, OH© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e805 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Islam Ghoneim More articles by this author Ho Yee Tiong More articles by this author Jesse Schold More articles by this author Titte Srinivas More articles by this author Charles Modlin More articles by this author Stuart Flechner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...