Kidney Transplants for the Elderly

Abstract

The number of elderly ESRD patients are on the rise worldwide, and in the United States nearly half of all prevalent ESRD patients are now over 60 years of age (1). Kidney transplantation offers the potential for improved quality and length of life for elderly patients (2–4), and reasonable outcomes have been reported for selected patients in their 70s and even 80s (3,4). However, the proportion of elderly patients on the transplant waiting list and receiving subsequent transplants remains relatively small: Approximately 9% of prevalent ESRD patients 60 or older were on the transplant waiting list in 2008. Of those 65 and older, the number of active candidates on the waiting list has more than doubled from 3695 in 1999 to 8606 in 2008 (1). In parallel, the number of “inactive” candidates (those placed on the waiting list yet not deemed to be current candidates, usually because of comorbidities) aged 65 and older on the waiting list has increased in the same time period approximately ninefold from 507 to 4584. As the number of patients placed on the waiting list has increased, the disparity between the number of transplant candidates and organ supply has inevitably resulted in increased waiting time and death on waiting list. These issues are more pronounced in elderly patients because of their higher mortality rates on dialysis. Some of the major challenges facing transplant programs relate to the evaluation, education, and list maintenance of elderly transplant candidates. Inescapable questions include those as follows: What is the likelihood that elderly ESRD patients would be deemed acceptable for listing for a transplant? How likely is it that they will they eventually be transplanted? In this issue of …