Abstract
The number of elderly patients with chronic kidney disease increases progressively, challenging the allocation algorithms in a scenario of organ shortage for transplantation. To evaluate the impact of age on patient and graft survival. Evolution of all 366 patients greater than 60 years transplanted between 1998 and 2010 was analyzed versus a control group of 366 younger patients matched for gender, type of donor (living or deceased) and year of transplantation. Diabetes mellitus (HR 1.8; IC 1.2-2.6; p = 0,003) and prioritization (HR 2.9; IC 1.2-2.6; p < 0,001), but not age, were independent factors for kidney graft loss. Advanced age was not related to negative outcomes after kidney transplantation, after excluding recipient death as a cause of allograft loss. Higher mortality rate in this group was associated to a higher frequency of comorbidities, especially diabetes mellitus.
Highlights
The number of elderly patients with chronic kidney disease increases progressively, challenging the allocation algorithms in a scenario of organ shortage for transplantation
That same year, only 10.8% of newly enlisted patients on the waiting list for transplant were senior citizens, despite this figure increasing 10 times since 1999.8 at the Kidney Hospital (HRIM), responsible for 20% of all kidney transplants performed in the country in the same year, only 12.5% of these transplants were allocated to this age range.[9]
As more recent data shows,[7] it is estimated that the number of dialysis patients reached 100,000 in 2013, being 30% the number of patients over age 65 in the last three years, during which period the population enrolled for transplantation in the same age range remained below 15%
Summary
Kidney transplantation is currently the best available treatment for end-stage chronic kidney failure (CKF).[1,2] In developed countries, besides providing a better quality of life, it enables a higher survival than what is offered by other forms of renal replacement therapy, at a lower cost.[3,4,5] These advantages can be found even among recipients aged over 60 years, regardless of donor characteristics.[6]. In 2009, about 40% of the more than 50,000 dialysis patients were older than 60 years.[7] that same year, only 10.8% of newly enlisted patients on the waiting list for transplant were senior citizens, despite this figure increasing 10 times since 1999.8 at the Kidney Hospital (HRIM), responsible for 20% of all kidney transplants performed in the country in the same year, only 12.5% of these transplants were allocated to this age range.[9] As more recent data shows,[7] it is estimated that the number of dialysis patients reached 100,000 in 2013, being 30% the number of patients over age 65 in the last three years, during which period the population enrolled for transplantation in the same age range remained below 15%.8 Factors such as lower life expectancy, higher association with other comorbidities, surgical risk and potential for serious complications have kept the elderly from having access to transplants. Graft loss was defined as return to dialysis or retransplantation
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