Abstract
With scarce organ supply, a selection of suitable elderly candidates for transplant is needed, as well as auditing the long-term outcomes after transplant. We conducted an observational cohort study among our patient cohort >60 years old with a long follow up. (1). Patients and Methods: We used our database to study the results after transplant for 593 patients >60 years old who underwent a transplant between 2000–2017. The outcome was compared between live donor (LD; n = 257) recipients, an old-to-old (OTO, n = 215) group using an extended criteria donor (ECD) kidney, and a young-to-old (YTO, n = 123) group using a standard-criteria donor. The Kaplan−Meir method was used to calculate the patient and graft survival and Cox regression analysis in order to find risk factors associated with death. (2). Results: The 5- and 10-year patient survival was significantly better in the LD group (92.7% and 66.9%) compared with the OTO group (73.3% and 42.8%) and YTO group (70.9% and 40.6%) (p < 0.0001). The 5- and 10-year graft survival rates were 90.3% and 68.5% (LD), 61.7% and 30.9% (OTO), and 64.1% and 39.9%, respectively (YTO group; p < 0.0001 between the LD and the two DD groups). There was no difference in outcome between patients in their 60’s and their 70’s. Factors associated with mortality included: age (HR-1.060), DM (HR-1.773), IHD (HR-1.510), and LD/DD (HR-2.865). (3). Conclusions: Our 17-years of experience seems to justify the rational of an old-to-old allocation policy in the elderly population. Live-donor transplant should be encouraged whenever possible. Each individual decision of elderly candidates for transplant should be based on the patient’s comorbidity and predicted life expectancy.
Highlights
Introduction published maps and institutional affilPatients ≥60 years old are the largest growing age group in the end-stage renal disease (ESRD) population and comprise 40% of all patients with ESRD
In the deceased donor young-to-old (DD-YTO) group, allocation was based on the following four parameters: time on dialysis, degree of pre-sensitization according to percent panel reactive antibody (PRA), B and DR-human leukocyte antigen (HLA)
The live donor (LD) patients had a shorter duration of dialysis before transplant, with 25% of them transplanted before the initiation of dialysis
Summary
This cohort study is based on a retrospective analysis of our center transplant database, including kidney transplants performed between 2000–2017. We used data of 593 kidney transplants in the elderly (aged >60 years) for the analysis. Data were extracted from the medical records of the relevant hospital departments, including outpatient clinics, surgery, and anesthesia, and consisted of the recipient’s and donor’s age and sex, cause of ESRD (diabetic nephropathy, hypertensive disease, polycystic kidneys disease (PKD), focal and segmental glomerulosclerosis (FSGS), glomerulonephritis (GN), pyelonephritis, congenital, others, and unknown), preoperative weight and BMI (kg/m2 ), comorbidities (diabetes mellitus (DM), ischemic heart disease (IHD), and hypertension (HTN)), dialysis duration before transplantation, graft from an LD or DD, panel reactive antibody (PRA), and human leukocyte antigen (HLA)-DR mismatch (MM). Outcomes and complications were determined by analyses of the patients, who all had their follow-ups at our transplant center
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