Background
In the recent past, advanced age was a contraindication to kidney transplantation
(KT). The purpose of this study was to review retrospectively our single center experience
in deceased donor (DD) KT with respect to recipient age.
Methods
From 10/1/01 to 9/1/06, we performed 356 adult DD KTs. Patients received antibody
induction in combination with tacrolimus, mycophenolate mofetil, and tapered steroids.
Results
A total of 114 (32%) patients were greater than 60 (including 25 >70 years), 186 (52%)
were 40-59 years of age, and 56 (16%) were 19-39 years of age. Of the 114 older patients,
61 (54%) received KTs from expanded criteria DDs (ECD), more than the younger age
groups (39% ECDs in patients 40-59 years versus 18% ECDs in patients 19-39 years,
P < .0001). Mean waiting time (21 mo) was less for patients greater than 60 years compared
with the other 2 groups combined (29 mo, P = .06). Patient survival was 91% in recipients greater than 60 years compared with
95% in those less than 60 years of age (P = NS) with a mean follow-up of 27 mo. Graft survival was similar for all 3 age groups
(82% >60 years vs 83% in patients 40-59 years vs 87% in patients 19-39 years, P = NS). Initial and subsequent graft function, morbidity, and resource use were similar
among groups. Patient survival [93% ECD vs 89% standard criteria DDs (SCD), P = NS) and graft survival (82% ECD vs 81% SCD, P = NS) rates were similar, whereas mean waiting times (18 mo ECD vs 25 mo SCD, P = .04) were less in patients greater than 60 years who received ECD KTs compared
with patients greater than 60 years who received SCD KTs.
Conclusions
Patients greater than 60 years account currently for one third of DD KTs performed
at our center, and more than half receive kidneys from ECDs. By preferentially directing
ECD kidneys to appropriately selected elderly patients, waiting times can be decreased
and survival is similar compared with SCD KTs in the elderly. In addition, short-term
outcomes can be achieved in patients greater than 60 years that are comparable with
those in younger patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The OPTN/UNOS renal transplant registry.in: Cecka J.M. Terasaki P.I. Clinical transplants 2005. UCLA Immunogenetics Center, Los Angeles2004: 1-6
United Network for Organ Sharing. National data. Available from: http://www.unos.org/data.
- The OPTN waiting list, 1988-2002.in: Cecka J.M. Terasaki P.I. Clinical transplants 2003. UCLA Immunogenetics Center, Los Angeles, Calif2004: 53-64
US Transplant—Scientific registry of transplant recipients. 2004 OPTN/SRTR Annual Report. Ann Arbor: University Renal Research and Education Association with the University of Michigan; 2004.
- Expanded criteria donors for kidney transplantation.Am J Transplant. 2003; 3: 114-125
- Multivariate analysis of donor risk factors for graft survival in kidney transplantation.Transplantation. 2003; 75: 361-367
- Kidney transplantation in patients aged sixty years and older.Surgery. 1990; 108: 726-731
- How old is old for transplantation?.Am J Transplant. 2004; 4: 2067-2074
- Matching older kidneys with older patients does not improve allograft survival.J Am Soc Nephrol. 2002; 13: 1067-1072
- Kidney transplantation in the elderly: age-matching as compared to HLA-matching: a single center experience.Transplantation. 2002; 73: 1356-1359
- Effect of donor recipient age match on survival after first deceased donor renal transplantation.J Am Soc Nephrol. 2004; 15: 1086-1091
- Evidence that the ratio of donor kidney weight to recipient body weight, donor age, and episodes of acute rejection correlate independently with live-donor graft function.Transplantation. 2002; 74: 280-283
- Interaction between donor and recipient age in determining the risk of chronic allograft failure.J Am Geriatr Soc. 2002; 50: 14-17
- Could more effective use of kidneys recovered from older deceased donors result in more kidney transplants for older patients?.Transplantation. 2006; 81: 966-970
- Relationship of recipient age and development of chronic allograft failure.Transplantation. 2000; 70: 306-310
- Patient and graft survival in older kidney transplant recipients: does age matter?.J Am Soc Nephrol. 2004; 15: 1052-1060
- Renal transplantation in the elderly: a long-term, single centre experience.Nephrol Dial Transplant. 2001; 16: 824-828
- Renal transplantation in older adults: is graft survival affected by age?.Transplantation. 2000; 69: 790-794
- Performance of different prediction equations for estimating renal function in kidney transplantation.Am J Transplant. 2004; 4: 1826-1835
- Experience with dual kidney transplants from donors at the extremes of age.Surgery. 2006; 140: 597-606
Stratta RJ, Moore PS, Farney AC, Rogers J, Hartmann EL, Reeves-Daniel A, et al. Influence of pulsatile perfusion preservation on outcomes in kidney transplantation from expanded criteria donors. J Am Coll Surg. In press.
- Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation: a spectrum or specter of quality?.Ann Surg. 2006; 243: 594-603
- Excerpts from the United States Renal Data System 2005 Annual Data Report: atlas of end-stage renal disease in the United States.Am J Kid Dis. 2006; 47: S65-S80
- Kidney Transplantation in the elderly: a decision analysis.J Am Soc Nephrol. 2003; 14: 187-196
- Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.N Engl J Med. 1999; 341: 1725-1730
- Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates.J Am Soc Nephrol. 2001; 12: 589-597
- Ageism and kidney transplantation.Am J Transplant. 2006; 6: 1264-1266
- A kidney for all ages.Am J Transplant. 2006; 6: 1267-1268
- State of renal transplantation in older Americans: an analysis of the UNOS database.Am J Transplant. 2004; 4 (A 1313): 517
- Deceased-donor characteristics and the survival benefit of kidney transplantation.JAMA. 2005; 294: 2726-2733
- Age-matching in renal transplantation.Nephrol Dial Transplant. 2000; 15: 696-700
- Evaluation of the Eurotransplant senior program.Am J Transplant. 2002; 2: 664-670
Article info
Publication history
Accepted:
August 22,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- ErratumSurgeryVol. 143Issue 2
- PreviewAs a result of a production error, several articles appearing in the Central Surgical Association (Surgery, 2007; Vol. 142, No. 4:433-644) and American Association of Endocrine Surgeons (Surgery, 2007; Vol. 142, No. 6:785-1030) special focus issues were published without their respective discussions. The articles affected have now been updated online to include the missing discussion material. Surgery apologizes to the authors for this significant oversight.
- Full-Text
- Preview
