Original InvestigationTransplantationAge and the Associations of Living Donor and Expanded Criteria Donor Kidneys With Kidney Transplant Outcomes
Section snippets
Patients
We extracted, refined, and examined data from all kidney transplant recipients listed in the SRTR up to December 2006. The SRTR data system includes data for all transplant donors, wait-listed candidates, and transplant recipients in the United States, which are submitted by members of the Organ Procurement and Transplantation Network. This study was approved by the Institutional Review Committees of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. Because of the large
Results
Using the SRTR database, we identified 145,470 adult kidney transplant recipients. There were 25,616 deaths (18%) and 22,876 transplant failures (16%). Median follow-up was 1,449 (25th-75th percentile, 636-2,497) days. Figure 1 shows the age distribution of the 145,470 kidney transplant patients. Only 11% of patients were older than 65 years. Table 1 lists clinical, demographic, laboratory, and transplant data for the 145,470 kidney transplant patients across 6 different age groups, including 3
Discussion
In 145,470 kidney transplant recipients, older age was associated with an incrementally higher risk of death. The association between age and death-censored transplant failure was U-shaped, indicating the highest risk of transplant failure in both young adults (18-<35 years) and very old patients (≥75 years) and the lowest risk in patients aged 55 to younger than 75 years. In patients older than 70 years, ECD kidney was not a significant predictor of death or transplant loss. However, in
Acknowledgements
The findings of this manuscript were included in an oral presentation during the American Society of Nephrology (ASN) Kidney Week, November 8-13, 2011, Philadelphia, PA.
We acknowledge the SRTR for providing the database for this research.
Support: The study was supported by research grant 0655776Y from the American Heart Association to Dr Kalantar-Zadeh. Dr Kalantar-Zadeh's other funding sources include the National Institute of Diabetes, Digestive and Kidney Diseases of the National Institutes
References (40)
- et al.
Incidence and hospital death rates associated with heart failure: a community-wide perspective
Am J Med
(2005) - et al.
The evolving challenge of evaluating older renal transplant candidates
Adv Chronic Kidney Dis
(2010) - et al.
“Old-for-old” cadaveric renal transplantation: surgical findings, perioperative complications and outcome
Eur Urol
(2003) - et al.
Predicting clinical outcome in the elderly renal transplant recipient
Kidney Int
(2000) - et al.
Renal transplantation in older people
Lancet
(1994) - et al.
Outcomes of kidney transplantation from older living donors to older recipients
Am J Kidney Dis
(2008) - et al.
Immunologic risk factors and glomerular C4d deposits in chronic transplant glomerulopathy
Kidney Int
(2004) - et al.
Antibody response against the glomerular basement membrane protein agrin in patients with transplant glomerulopathy
Am J Transplant
(2005) - et al.
Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006
Diabetes Care
(2009) - et al.
Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004
Hypertension
(2007)
Incidence of end-stage renal disease in the elderly: a steadily rising global socioeconomic epidemic
Int Urol Nephrol
USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States
The 2008 SRTR Report on the State of Transplantation
Successful treatment of middle aged and elderly patients with end stage renal disease
Br Med J
Renal replacement therapy in elderly patients
Transpl Int
Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant
N Engl J Med
A comparison of the effects of dialysis and renal transplantation on the survival of older uremic patients
Transplantation
How great is the survival advantage of transplantation over dialysis in elderly patients?
Nephrol Dial Transplant
Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients
Transplantation
Survival benefits of kidney transplantation with expanded criteria deceased donors in patients aged 60 years and over
Transplantation
Cited by (76)
Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis
2023, European Urology Open ScienceOlder Age is Associated With Lower Utilization of Living Donor Kidney Transplant
2023, Kidney International ReportsLong-term Outcome Reporting in Older Kidney Transplant Recipients and the Limitations of Conventional Survival Metrics
2022, Kidney International ReportsCitation Excerpt :The flowchart of patient selection is shown in Supplementary Figure S3. Patients were stratified into 4 age groups using the cut-off age points of 55 years (the median age of kidney recipients from 2015 onwards), 65 years and 75 years (commonly used cut-offs to define older and very old adults, respectively, in census reports and transplant literature7,8,11-14). This study was approved by the Massachusetts General Hospital Institutional Review Board (protocol number 2020P002874).
Outcome of Lung Transplantation Using Grafts From Donors Over 65 Years of Age
2021, Annals of Thoracic SurgeryKidney Transplant Outcomes in elderly Recipients: An Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry Study
2021, Transplantation ProceedingsCitation Excerpt :Transplantation of donor kidneys aged ≥65 years has been associated with decreased recipient and graft survival, although outcomes remained superior compared with remaining on dialysis [20,21]. It has been previously reported that elderly recipients of ECD kidneys have similar patient and graft survival rates compared with elderly recipients of non-ECD kidneys [22]. However, the similar rejection rates we observed when comparing elderly and younger recipients of deceased donor kidneys is an unexpected finding and may be related to the high proportion of lower quality kidneys transplanted into the elderly group.
Living donor nephrectomy: The French guidelines from CTAFU
2021, Progres en Urologie
Originally published online February 10, 2012.
- ⁎
M.Z.M. and E.S. contributed equally to this work.