Kidney Transplantation in Recipients Older Than 70 Years Old

Abstract

Patients older than 70 years are the fastest growing age group of patients incident on renal replacement therapy, presenting a high mortality in the first 3 years of being included on dialysis. Kidney transplantation should not be considered as an option for these patients because of their morbidity, presenting a lower proportion of patients included on the waiting list in the different registries all over the world. However, kidney transplantation could be a useful option in cases of selected patients of older age. Aim To compare the evolution of kidney transplant recipients older than 70 years (R>70) with patients younger than 70 years (R<70) in our series. Material and Methods We analyzed 889 kidney trasplants adult recipients. We compared R>70 (n: 54, 5,5%) to R<70 (n=833). Follow-up: 85,3 ± 65,27 months (r : 0 - 239,7). Mean recipient age was 71,7 ± 1,7 years in R>70 vs 51,1 ± 12,2 in R<70 (p <0,001). No differences were found in high blood pressure, body mass index, ischemic miocardiopathy, stroke, peripheric vasculopathy or diabetes mellitus pretransplantation. Left ventricular hypertrophy or dyslipidemia were more prevalent and tobacco was less frequent in R>70 (p<0,05) . R>70 received grafts from older donors (p<0,001), more frequently women (p=0,024), cerebrovascular death (p<0,001), high blood pressure (p<0,001) and higher serum creatinine levels (p=0,002). No differences were found in retransplant patients or cold ischemia time. R>70 presented higher mismatches (p=0,001), they received more frequently reduced thymoglobuline doses for induction (p<0,001) and tacrolimus (p=0,027). Early acute rejection was lower in R>70 (p=0,075). Serum creatinine was slightly higher in R>70 during the first 2 years after transplantation, but only statistical differences were found during the first month (p=0,007). Graft survival (non-censored data) was similar (p=0,085). Main causes of graft failure were chronic dysfunction and death with functioning graft in R>70. Patient survival was lower (p<0,001) in R>70. Infectious death was the most frequent cause, followed by cardiovascular disease and cancer (p=0,022). Conclusions Kidney transplantation, in selected recipients older than 70 years, related to a graft survival similar to that of younger recipients with an acceptable renal function, but with a lower patient survival. We consider that kidney transplant should be considered an acceptable option for selected older patients.