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Quality of Life of Older Patients Undergoing Renal Transplantation: Finding the Right Immunosuppressive Treatment

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Abstract

Kidney transplantation is currently the best treatment for end-stage renal disease, both in terms of mortality benefit and quality of life (QOL). Elderly patients are a rapidly growing subset of the kidney transplant waiting list. While it is clear that elderly individuals have a mortality benefit from kidney transplant, it is less clear how to make sure these individuals benefit from optimal QOL following transplant. Several studies demonstrate superiority of some immunosuppressive regimens over others in the QOL domain. Tacrolimus has been shown to be associated with better QOL than cyclosporine (ciclosporin), as has corticosteroid-free immunosuppressive regimens. Similarly, patients on drug regimens, which tend to lessen the side effects, report better QOL. However, these studies are observational or cross-sectional and not focused exclusively on the elderly patient. More studies are needed to determine optimal immunosuppression regimens for elderly individuals. Additionally, further studies on determinants of QOL in elderly kidney transplant recipients are also needed.

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References

  1. Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11(10):2093–109.

    CAS  PubMed  Google Scholar 

  2. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. 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(23):1725–30.

    Article  CAS  PubMed  Google Scholar 

  3. Butt Z, Yount SE, Caicedo JC, Abecassis MM, Cella D. Quality of life assessment in renal transplant: review and future directions. Clin Transplant. 2008;22(3):292–303.

    Google Scholar 

  4. Molnar-Varga M, Molnar MZ, Szeifert L, Kovacs AZ, Kelemen A, Becze A, et al. Health-related quality of life and clinical outcomes in kidney transplant recipients. Am J Kidney Dis. 2011;58(3):444–52.

    Article  PubMed  Google Scholar 

  5. Rao PS, Schaubel DE, Wei G, Fenton SS. Evaluating the survival benefit of kidney retransplantation. Transplantation. 2006;82(5):669–74.

    Article  PubMed  Google Scholar 

  6. U.S. Renal Data System, USRDS 2012 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2012. http://www.usrds.org/2012/pdf/v2_ch1_12.pdf. Accessed 1 Feb 2013.

  7. OPTN/SRTR 2011 annual data report. HHS/HRSA/HSB/DOT. http://srtr.transplant.hrsa.gov/annual_reports/2011/pdf/01_kidney_12.pdf. Accessed 1 Feb 2013.

  8. Danovitch G, Savransky E. Challenges in the counseling and management of older kidney transplant candidates. Am J Kidney Dis. 2006;47(4 Suppl 2):S86–97.

    Article  PubMed  Google Scholar 

  9. Sayegh MH, Carpenter CB. Transplantation 50 years later–progress, challenges, and promises. N Engl J Med. 2004;351(26):2761–6.

    Article  CAS  PubMed  Google Scholar 

  10. Huang E, Poommipanit N, Sampaio MS, Kuo HT, Reddy P, Gritsch HA, et al. Intermediate-term outcomes associated with kidney transplantation in recipients 80 years and older: an analysis of the OPTN/UNOS database. Transplantation. 2010;90(9):974–9.

    Article  CAS  PubMed  Google Scholar 

  11. Rosner M, Abdel-Rahman E, Williams ME. Geriatric nephrology: responding to a growing challenge. Clin J Am Soc Nephrol. 2010;5(5):936–42.

    Article  PubMed  Google Scholar 

  12. Fiebiger W, Mitterbauer C, Oberbauer R. Health-related quality of life outcomes after kidney transplantation. Health Qual Life Outcomes. 2004;2:2.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Hathaway D, Winsett R, Prendergast M, Subaiya I. The first report from the patient outcomes registry for transplant effects on life (PORTEL): differences in side-effects and quality of life by organ type, time since transplant and immunosuppressive regimens. Clin Transplant. 2003;17(3):183–94.

    Article  PubMed  Google Scholar 

  14. Jofre R, Lopez-Gomez JM, Moreno F, Sanz-Guajardo D, Valderrabano F. Changes in quality of life after renal transplantation. Am J Kidney Dis. 1998;32(1):93–100.

    Article  CAS  PubMed  Google Scholar 

  15. Rebollo P, Ortega F, Baltar JM, Diaz-Corte C, Navascues RA, Naves M, et al. Health-related quality of life (HRQOL) in end stage renal disease (ESRD) patients over 65 years. Geriatr Nephrol Urol. 1998;8(2):85–94.

    Article  CAS  PubMed  Google Scholar 

  16. Humar A, Denny R, Matas AJ, Najarian JS. Graft and quality of life outcomes in older recipients of a kidney transplant. Exp Clin Transplant. 2003;1(2):69–72.

    PubMed  Google Scholar 

  17. Cetingok M, Winsett RP, Hathaway DK. A comparative study of quality of life among the age groups of kidney transplant recipients. Prog Transplant. 2004;14(1):33–8.

    PubMed  Google Scholar 

  18. Liu H, Feurer ID, Dwyer K, Speroff T, Shaffer D, Wright Pinson C. The effects of gender and age on health-related quality of life following kidney transplantation. J Clin Nurs. 2008;17(1):82–9.

    Google Scholar 

  19. Cornella C, Brustia M, Lazzarich E, Cofano F, Ceruso A, Barbe MC, et al. Quality of life in renal transplant patients over 60 years of age. Transplant Proc. 2008;40(6):1865–6.

    Google Scholar 

  20. Rosenberger J, van Dijk JP, Nagyova I, Roland R, Geckova AM, van den Heuvel WJ, et al. Do dialysis- and transplantation-related medical factors affect perceived health status? Nephrol Dial Transplant. 2005;20(10):2153–8.

    Google Scholar 

  21. Rebollo P, Ortega F, Baltar JM, Alvarez-Ude F, Alvarez Navascues R, Alvarez-Grande J. Is the loss of health-related quality of life during renal replacement therapy lower in elderly patients than in younger patients? Nephrol Dial Transplant. 2001;16(8):1675–80.

    Google Scholar 

  22. Oppenheimer F, Rebollo P, Grinyo JM, Ortega F, Sanchez-Plumed J, Gonzalez-Molina M, et al. Health-related quality of life of patients receiving low-toxicity immunosuppressive regimens: a substudy of the Symphony Study. Transplantation. 2009;87(8):1210–3.

    Article  PubMed  Google Scholar 

  23. Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med. 2004;351(26):2715–29.

    Article  CAS  PubMed  Google Scholar 

  24. De Geest S, Moons P. The patient’s appraisal of side-effects: the blind spot in quality-of-life assessments in transplant recipients. Nephrol Dial Transplant. 2000;15(4):457–9.

    Article  PubMed  Google Scholar 

  25. Falck P, Asberg A, Byberg KT, Bremer S, Bergan S, Reubsaet JL, et al. Reduced elimination of cyclosporine A in elderly (>65 years) kidney transplant recipients. Transplantation. 2008;86(10):1379–83.

    Article  CAS  PubMed  Google Scholar 

  26. Meier-Kriesche HU, Kaplan B. Immunosuppression in elderly renal transplant recipients: are current regimens too aggressive? Drugs Aging. 2001;18(10):751–9.

    Article  CAS  PubMed  Google Scholar 

  27. Reimer J, Franke GH, Philipp T, Heemann U. Quality of life in kidney recipients: comparison of tacrolimus and cyclosporine-microemulsion. Clin Transplant. 2002;16(1):48–54.

    Article  PubMed  Google Scholar 

  28. Bohlke M, Rocha M, Gomes RH, Marini SS, Terhorst L, Barcellos FC, et al. Tacrolimus and quality of life after kidney transplantation–a multicenter study. Clin Transplant. 2006;20(4):504–8.

    Google Scholar 

  29. Artz MA, Boots JM, Ligtenberg G, Roodnat JI, Christiaans MH, Vos PF, et al. Conversion from cyclosporine to tacrolimus improves quality-of-life indices, renal graft function and cardiovascular risk profile. Am J Transplant. 2004;4(6):937–45.

    CAS  PubMed  Google Scholar 

  30. Moons P, Vanrenterghem Y, van Hooff JP, Squifflet JP, Margodt D, Mullens M, et al. Steroids may compromise quality of life of renal transplant recipients on a tacrolimus-based regimen. Transplant Proc. 2002;34(5):1691–2.

    Article  CAS  PubMed  Google Scholar 

  31. Oberbauer R, Hutchison B, Eris J, Arias M, Claesson K, Mota A, et al. Health-related quality-of-life outcomes of sirolimus-treated kidney transplant patients after elimination of cyclosporine A: results of a 2-year randomized clinical trial. Transplantation. 2003;75(8):1277–85.

    Article  PubMed  Google Scholar 

  32. Meier-Kriesche HU, Friedman G, Jacobs M, Mulgaonkar S, Vaghela M, Kaplan B. Infectious complications in geriatric renal transplant patients: comparison of two immunosuppressive protocols. Transplantation. 1999;68(10):1496–502.

    Article  CAS  PubMed  Google Scholar 

  33. Meier-Kriesche HU, Ojo A, Hanson J, Cibrik D, Lake K, Agodoa LY, et al. Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation. 2000;69(5):885–9.

    Article  CAS  PubMed  Google Scholar 

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Conflicts of Interest

R. Perlman and P.S. Rao declare no relevant conflicts of interest. No sources of funding were used to support the writing of this manuscript.

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Authors and Affiliations

  1. Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA

    Rachel L. Perlman

  2. Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, 102 Observatory Road, Simpson Memorial Building, Ann Arbor, MI, 48109, USA

    Rachel L. Perlman & Panduranga S. Rao

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  1. Rachel L. Perlman
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  2. Panduranga S. Rao
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Correspondence to Panduranga S. Rao.

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Perlman, R.L., Rao, P.S. Quality of Life of Older Patients Undergoing Renal Transplantation: Finding the Right Immunosuppressive Treatment. Drugs Aging 31, 103–109 (2014). https://doi.org/10.1007/s40266-013-0149-x

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