Renal Transplantation

Abstract

The population of patients who have ESRD and are older than 65 yr now outnumbers those who are younger than 65 yr. In fact, the number of patients who started dialysis over the age of 80 nearly doubled from 1996 ( n = 7054) to 2003 ( n = 13,557) (1). Who and when to refer the senior and elderly population presents a challenge to the community of nephrologists who care for them, both while on dialysis and in advanced stages of chronic kidney disease. Existing data suggest that, once they undergo transplantation, older patients actually do quite well from both a quality- and a quantity-of-life perspective (2). The natural consequence of aging, especially with chronic kidney disease, is the accumulation of an increasing burden of comorbidities, cardiovascular and cerebrovascular disease in particular. This study attempted to ascertain risk factors that were useful in predicting transplant outcome in patients as they advanced in age. The researchers used robust retrospective data from the Norwegian Renal Registry and reviewed all patients who underwent transplantation at a single hospital from 1990 through 2005 with follow-up data available until May 1, 2008. Patients were grouped into three categories: Elderly (≥70 yr; n = 354), senior (60 to 69 yr; n = 577), and control (45 to 54 yr; n = 563) and included only first kidney transplant recipients. A standard Cox model approach (analysis using univariate and forward stepwise regression) with end points of death, death-censored graft loss, or uncensored graft loss was used to assess patient and graft survival. Comorbidity at the time of transplantation was assessed retrospectively using the Charlson Comorbidity Index, a tool considered to be a robust index of comorbidity in transplant patients (3). Data were also collected for immunosuppressive therapy (initially azathioprine, steroids, and cyclosporine; subsequently basiliximab with mycophenolate mofetil, cyclosporine, …