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Changing Landscape of Solid Organ Transplantation for Older Adults: Trends and Post-Transplant Age-Related Outcomes

  • Frailty and Gerontology (M. McAdams-Demarco, Section Editor)
  • Published:
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Abstract

Purpose of Review

The prevalence of older adults with end organ failure is increasing. This review summarizes recent trends in waitlisting of patients age 65 years and older for solid organ transplantation. Recent data on post-transplantation outcomes in this population are also reviewed.

Recent Findings

Waitlisting and transplantation rates in older adults are increasing across all categories of solid organ transplantation. Though survival is worse when compared with that in a younger population, survival remains robust and many patients in this population benefit from transplantation. Compared with younger adults, acute rejection is lower; however, 5-year graft survival is worse. Data is sparse on other outcomes such as quality of life and functional status.

Summary

The population of older adults being listed for solid organ transplantation is likely to continue to grow. Research is needed to evaluate what subgroups will benefit most from this treatment.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Colvin M, Smith JM, Hadley N, Skeans MA, Uccellini K, Lehman R, et al. OPTN/SRTR 2017 annual data report: heart. Am J Transplant. 2019;19(S2):323–403.

    PubMed  Google Scholar 

  2. Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S, et al. OPTN/SRTR 2017 annual data report: kidney. Am J Transplant. 2019;19(S2):19–123.

    PubMed  Google Scholar 

  3. Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Noreen SM, et al. OPTN/SRTR 2017 annual data report: liver. Am J Transplant. 2019;19(S2):184–283.

    PubMed  Google Scholar 

  4. Valapour M, Lehr CJ, Skeans MA, Smith JM, Uccellini K, Lehman R, et al. OPTN/SRTR 2017 annual data report: lung. Am J Transplant. 2019;19(S2):404–84.

    PubMed  Google Scholar 

  5. • Segall L, Nistor I, Pascual J, Mucsi I, Guirado L, Higgins R, et al. Criteria for and appropriateness of renal transplantation in elderly patients with end-stage renal disease: a literature review and position statement on behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice. Transplantation. 2016;100(10):e55–65 Consensus statement summarizing data evaluating the risks and benefits of KT in older adults and recommendations concerning eligibility and overcoming donor organ shortages.

    PubMed  Google Scholar 

  6. Mehra MR, Kobashigawa J, Starling R, Russell S, Uber PA, Parameshwar J, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006. J Heart Lung Transplant. 2006;25(9):1024–42.

    PubMed  Google Scholar 

  7. Durand F, Levitsky J, Cauchy F, Gilgenkrantz H, Soubrane O, Francoz C. Age and liver transplantation. J Hepatol. 2018.

  8. United States Renal Data System, 2018 Annual Data Report.

  9. Dusseux E, Albano L, Fafin C, Hourmant M, Guérin O, Couchoud C, et al. A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation. Kidney Int. 2015;88(1):121–9.

    PubMed  Google Scholar 

  10. Grams ME, Kucirka LM, Hanrahan CF, Montgomery RA, Massie AB, Segev DL. Candidacy for kidney transplantation of older adults. J Am Geriatr Soc. 2012;60(1):1–7.

    PubMed  PubMed Central  Google Scholar 

  11. Karim A, Farrugia D, Cheshire J, Mahboob S, Begaj I, Ray D, et al. Recipient age and risk for mortality after kidney transplantation in England. Transplantation. 2014;97(8):832–8.

    PubMed  Google Scholar 

  12. • Su F, Yu L, Berry K, Liou IW, Landis CS, Rayhill SC, et al. Aging of liver transplant registrants and recipients: trends and impact on waitlist outcomes, post-transplantation outcomes, and transplant-related survival benefit. Gastroenterology. 2016;150(2):441–53. e6 Key study showing increasing proportion of older adults being listed for OLT, and increased post-transplant mortality in older adults.

    PubMed  Google Scholar 

  13. Gil E, Kim JM, Jeon K, Park H, Kang D, Cho J, et al. Recipient age and mortality after liver transplantation: a population-based cohort study. Transplantation. 2018;102(12):2025–32.

    PubMed  PubMed Central  Google Scholar 

  14. Sonny A, Kelly D, Hammel JP, Albeldawi M, Zein N, Cywinski JB. Predictors of poor outcome among older liver transplant recipients. Clin Transpl. 2015;29(3):197–203.

    CAS  Google Scholar 

  15. Wang CW, Covinsky KE, Feng S, Hayssen H, Segev DL, Lai JC. Functional impairment in older liver transplantation candidates: from the functional assessment in liver transplantation study. Liver Transpl. 2015;21(12):1465–70.

    PubMed  Google Scholar 

  16. Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014—an update from the pulmonary transplantation Council of the International Society for Heart and Lung Transplantation. Elsevier; 2015.

  17. Courtwright A, Cantu E. Lung transplantation in elderly patients. J Thorac Dis. 2017;9(9):3346–51.

    PubMed  PubMed Central  Google Scholar 

  18. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LYC, 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.

    CAS  PubMed  Google Scholar 

  19. Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK. Renal transplantation in elderly patients older than 70 years of age: results from the scientific registry of transplant recipients. Transplantation. 2007;83(8):1069–74.

    PubMed  Google Scholar 

  20. Adani GL, Baccarani U, Crestale S, Pravisani R, Isola M, Tulissi P, et al. Kidney transplantation in elderly recipients: a single-center experience. Transplant Proc. 2019;51(1):132–5.

    CAS  PubMed  Google Scholar 

  21. Lønning K, Midtvedt K, Leivestad T, Reisæter AV, Line P-D, Hartmann A, et al. Are octogenarians with end-stage renal disease candidates for renal transplantation? Transplantation. 2016;100(12):2705–9.

    PubMed  PubMed Central  Google Scholar 

  22. Kauffman HM, McBride MA, Cors CS, Roza AM, Wynn JJ. Early mortality rates in older kidney recipients with comorbid risk factors. Transplantation. 2007;83(4):404–10.

    PubMed  Google Scholar 

  23. Faravardeh A, Eickhoff M, Jackson S, Spong R, Kukla A, Issa N, et al. Predictors of graft failure and death in elderly kidney transplant recipients. Transplantation. 2013;96(12):1089–96.

    PubMed  Google Scholar 

  24. Ma MK, Lim WH, Craig JC, Russ GR, Chapman JR, Wong G. Mortality among younger and older recipients of kidney transplants from expanded criteria donors compared with standard criteria donors. Clin J Am Soc Nephrol. 2016;11(1):128–36.

    CAS  PubMed  Google Scholar 

  25. • Jay CL, Washburn K, Dean PG, Helmick RA, Pugh JA, Stegall MD. Survival benefit in older patients associated with earlier transplant with high KDPI kidneys. Transplantation. 2017;101(4):867 Key study showing the benefit of high KDPI kidneys in older adults listed for kidney transplant.

    PubMed  PubMed Central  Google Scholar 

  26. Massie AB, Luo X, Chow EKH, Alejo JL, Desai NM, Segev DL. Survival benefit of primary deceased donor transplantation with high-KDPI kidneys. Am J Transplant. 2014;14(10):2310–6.

    CAS  PubMed  Google Scholar 

  27. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol. 2001;12(12):2797–806.

    CAS  PubMed  Google Scholar 

  28. Lowrie EG, Curtin RB, LePain N, Schatell D. Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis. 2003;41(6):1286–92.

    PubMed  Google Scholar 

  29. Mapes DL, Lopes AA, Satayathum S, Mccullough KP, Goodkin DA, Locatelli F, et al. Health-related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int. 2003;64(1):339–49.

    PubMed  Google Scholar 

  30. Lønning K, Heldal K, Bernklev T, Brunborg C, Andersen MH, Von der Lippe N, et al. Improved health-related quality of life in older kidney recipients 1 year after transplantation. Transplant Direct. 2018;4(4).

  31. Pinter J, Hanson CS, Craig JC, Chapman JR, Budde K, Halleck F, et al. ‘I feel stronger and younger all the time’—perspectives of elderly kidney transplant recipients: thematic synthesis of qualitative research. Nephrol Dial Transplant. 2016;31(9):1531–40.

    PubMed  Google Scholar 

  32. Pinter J, Hanson CS, Chapman JR, Wong G, Craig JC, Schell JO, et al. Perspectives of older kidney transplant recipients on kidney transplantation. Clin J Am Soc Nephrol. 2017;12(3):443–53.

    PubMed  PubMed Central  Google Scholar 

  33. Sharma M, Ahmed A, Wong RJ. Significantly higher mortality following liver transplantation among patients aged 70 years and older. Prog Transplant. 2017;27(3):225–31.

    PubMed  Google Scholar 

  34. Asrani SK, Saracino G, O'Leary JG, Gonzales S, Kim PT, McKenna GJ, et al. Recipient characteristics and morbidity and mortality after liver transplantation. J Hepatol. 2018;69(1):43–50.

    PubMed  Google Scholar 

  35. Haugen CE, Holscher CM, Luo X, Bowring MG, Orandi BJ, Thomas AG, et al. Assessment of trends in transplantation of liver grafts from older donors and outcomes in recipients of liver grafts from older donors, 2003-2016. JAMA Surg. 2019;154(5):441–9.

    PubMed  PubMed Central  Google Scholar 

  36. Oezcelik A, Dayangac M, Guler N, Yaprak O, Erdogan Y, Akyildiz M, et al. Living donor liver transplantation in patients 70 years or older. Transplantation. 2015;99(7):1436–40.

    CAS  PubMed  Google Scholar 

  37. Ikegami T, Bekki Y, Imai D, Yoshizumi T, Ninomiya M, Hayashi H, et al. Clinical outcomes of living donor liver transplantation for patients 65 years old or older with preserved performance status. Liver Transpl. 2014;20(4):408–15.

    PubMed  Google Scholar 

  38. Croome KP, Lee DD, Burns JM, Perry DK, Nguyen JH, Keaveny AP, et al. Simultaneous liver and kidney transplantation in elderly patients: outcomes and validation of a clinical risk score for patient selection. Ann Hepatol. 2017;15(6):870–80.

    Google Scholar 

  39. Cooper LB, Lu D, Mentz RJ, Rogers JG, Milano CA, Felker GM, et al. Cardiac transplantation for older patients: characteristics and outcomes in the septuagenarian population. J Heart Lung Transplant. 2016;35(3):362–9.

    PubMed  Google Scholar 

  40. Foroutan F, Alba AC, Guyatt G, Posada JD, Hing NNF, Arseneau E, et al. Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis. Heart. 2018;104(2):151–60.

    CAS  PubMed  Google Scholar 

  41. Ehrsam JP, Benden C, Seifert B, Opitz I, Schneiter D, Weder W, et al. Lung transplantation in the elderly: influence of age, comorbidities, underlying disease, and extended criteria donor lungs. J Thorac Cardiovasc Surg. 2017;154(6):2135–41.

    PubMed  Google Scholar 

  42. • Roy SB, Alarcon D, Walia R, Chapple KM, Bremner RM, Smith MA. Is there an age limit to lung transplantation? Ann Thorac Surg. 2015;100(2):443–51 Key study highlighting survival in elderly lung transplant recipients with an analysis of single versus bilateral lung transplant.

    Google Scholar 

  43. Hayanga AJ, Aboagye JK, Hayanga HE, Morrell M, Huffman L, Shigemura N, et al. Contemporary analysis of early outcomes after lung transplantation in the elderly using a national registry. J Heart Lung Transplant. 2015;34(2):182–8.

    PubMed  Google Scholar 

  44. Genao L, Whitson HE, Zaas D, Sanders LL, Schmader KE. Functional status after lung transplantation in older adults in the post-allocation score era. Am J Transplant. 2013;13(1):157–66.

    CAS  PubMed  Google Scholar 

  45. Singer JP, Katz PP, Soong A, Shrestha P, Huang D, Ho J, et al. Effect of lung transplantation on health-related quality of life in the era of the lung allocation score: a U.S. prospective cohort study. Am J Transplant. 2017;17(5):1334–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A. 2001;56(3):M146–M57.

    CAS  Google Scholar 

  47. Haugen CE, Chu NM, Ying H, Warsame F, Holscher CM, Desai NM, et al. Frailty and access to kidney transplantation. Clin J Am Soc Nephrol. 2019;14(4):576–82.

    PubMed  PubMed Central  Google Scholar 

  48. Lai JC, Feng S, Terrault NA, Lizaola B, Hayssen H, Covinsky K. Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant. 2014;14(8):1870–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Jha SR, Hannu MK, Chang S, Montgomery E, Harkess M, Wilhelm K, et al. The prevalence and prognostic significance of frailty in patients with advanced heart failure referred for heart transplantation. Transplantation. 2016;100(2):429–36.

    PubMed  Google Scholar 

  50. Singer JP, Diamond JM, Gries CJ, McDonnough J, Blanc PD, Shah R, et al. Frailty phenotypes, disability, and outcomes in adult candidates for lung transplantation. Am J Respir Crit Care Med. 2015;192(11):1325–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. McAdams-DeMarco M, Law A, King E, Orandi B, Salter M, Gupta N, et al. Frailty and mortality in kidney transplant recipients. Am J Transplant. 2015;15(1):149–54.

    CAS  PubMed  Google Scholar 

  52. • Haugen CE, McAdams-DeMarco M, Holscher CM, Ying H, Gurakar AO, Garonzik-Wang J, et al. Multicenter study of age, frailty, and waitlist mortality among liver transplant candidates. Ann Surg. 2019. Key study showing higher rates of frailty in older adult OLT candidates, and increased wait list mortality in frail adults.

  53. Garonzik-Wang JM, Govindan P, Grinnan JW, Liu M, Ali HM, Chakraborty A, et al. Frailty and delayed graft function in kidney transplant recipients. Arch Surg. 2012;147(2):190–3.

    PubMed  Google Scholar 

  54. McAdams-DeMarco MA, Law A, Salter ML, Chow E, Grams M, Walston J, et al. Frailty and early hospital readmission after kidney transplantation. Am J Transplant. 2013;13(8):2091–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Reese PP, Shults J, Bloom RD, Mussell A, Harhay MN, Abt P, et al. Functional status, time to transplantation, and survival benefit of kidney transplantation among wait-listed candidates. Am J Kidney Dis. 2015;66(5):837–45.

    PubMed  PubMed Central  Google Scholar 

  56. Jha SR, Hannu MK, Newton PJ, Wilhelm K, Hayward CS, Jabbour A, et al. Reversibility of frailty after bridge-to-transplant ventricular assist device implantation or heart transplantation. Transplant Direct. 2017;3(7).

  57. Lai JC, Sonnenday CJ, Tapper EB, Duarte-Rojo A, Dunn MA, Bernal W, et al. Frailty in liver transplantation: an expert opinion statement from the American Society of Transplantation Liver and Intestinal Community of Practice. Am J Transplant. 2019.

  58. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35(1):1–23.

    PubMed  Google Scholar 

  59. • Kobashigawa J, Dadhania D, Bhorade S, Adey D, Berger J, Bhat G, et al. Report from the American Society of Transplantation on frailty in solid organ transplantation. Am J Transplant. 2019;19(4):984–94 Recent consensus statement outlining current understanding of frailty in transplant and suggesting areas for future research.

    PubMed  Google Scholar 

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  1. Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, 622 West 168th Street, PH4-124, New York, NY, 10032, USA

    Vaqar H. Shah & Maya K. Rao

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  1. Vaqar H. Shah
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Correspondence to Maya K. Rao.

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Shah, V.H., Rao, M.K. Changing Landscape of Solid Organ Transplantation for Older Adults: Trends and Post-Transplant Age-Related Outcomes. Curr Transpl Rep 7, 38–45 (2020). https://doi.org/10.1007/s40472-020-00275-1

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