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Renal transplantation in patients above 60 years of age in the modern era: A single center experience with a review of the literature

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Abstract

A retrospective study was conducted of 797 patients receiving renal transplants from January 1985 to March 1997. Patient and graft survival was compared for patients above and below the age of 60. Sixty-ninepatients ≤60 years old received 73 kidneys. Race: 73% Caucasian, 26% Black, 1% Other. Sex: 68%M. Hypertension (19) and PCKD (15) were the most common diagnoses. Mean peak panel reactive antibody (PRA) was 37.7%. Donor age was 2 to 66 years. Mean Cold ischemic time was 28.1 hours. Follow-up was untildeath or until 8/30/97. Patients <60 years included:62% Caucasian, 34% Black, 4% Other, 60% male, Mean PRA 39.3.

Of the 69 study patients, 27 died: 19 with afunctioning graft, 8 within one year oftransplantation. Cardiovascular causes (19 patients,72%) and infection (7 patients, 24%) were mostcommon. Common causes of graft loss were death witha functioning graft (19) and chronic rejection (15);other causes were acute rejection and primarynon-function. Univariate analysis of 18 risk factorsshowed CHF and past history of vascular surgerysignificantly (p < 0.05) affected time of return todialysis. Multi variate analysis did not show theseindependent variables to be significant. Abnormalejection fraction and presence of q waves on EKGsignificantly affected time to death (p < 0.05) on uniand multi-variate analysis. After censoring patientsthat died with functioning grafts, difference in graftsurvival between ≥60 and <59 years was notsignificant (p > 0.2).

In this study, 68% of older patients had allograftsfunctioning at 1 year. The fact that older patientssuccumb over time from natural causes should not keeppatients from transplantation. Immunosuppressiveagents need to be limited to reduce the incidence ofinfection. Criteria need to be refined to define thosewho are at prohibitive risk, who may not be candidatesfor transplantation.

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References

  1. Ismail N, Hakim RM, Helderman JH. Renal replacement therapies in the elderly: Part II. Renal transplantation. American Journal of Kidney Diseases 1994; 23(1): 1–15.

    PubMed  CAS  Google Scholar 

  2. ACC/AHA Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery. Circulation 1996; 93(6): 1280–1311.

    Google Scholar 

  3. Tesi RJ, Elkhammas EA, Davies EA, Henry ML, Ferguson RM. Renal transplantation in older people. Lancet 1994; 343: 461–464.

    Article  PubMed  CAS  Google Scholar 

  4. Fryd DS, Kruse LVG, Simmons RL, Sutherland DER, Payne WD, Najarian JS. Donor source, number of transplant, age at transplant, and diabetes: Risk factors in the Cyclosporine Era. Transplantation Proceedings 1989; 21(1): 1655–1656.

    PubMed  CAS  Google Scholar 

  5. Cardella CJ, Oreopoulos DG, Uldall R, Honey J, Cook G, deVeber GA. Renal transplantation in patients 60 years of age or older. Transplantation Proceedings 1986; 18(1): 151–152.

    Google Scholar 

  6. Mandelbaum DM, Henry ML, Sommer BG, Ferguson RM. Primary cadaveric renal transplantation using cyclosporine in patients over fifty years of age. Transplantation Proceedings 1987; 19(1): 1863–1864.

    PubMed  CAS  Google Scholar 

  7. Lundgren G, Persson H, Albrechtsen D et al. Recipient age - an important factor for the outcome of cadaver renal transplantation in patients treated with cyclosporine. Transplantation Proceedings 1989; 21(1): 1653–1654.

    PubMed  CAS  Google Scholar 

  8. Mourad G, Cristol JP, Vela C, Hauet T, Iborra F, Chong G. Cadaveric renal transplantation in patients 60 years of age or older: Experience with 58 patients in a single center. Nephrol Dial Transplant 1995; 10(suppl. 6): 105–107.

    PubMed  Google Scholar 

  9. Vivas CA, Hickey DP, Jordan ML et al. Renal transplantation in patients 65 years old or older. J Urol 1992; 147: 990–993.

    PubMed  CAS  Google Scholar 

  10. Morris GE, Jamieson NV, Small J, Evans DB, Calne R. Cadaveric renal transplantation in elderly recipients: Is it worthwhile? Nephrol Dial Transplant 1991; 6: 887–892.

    PubMed  CAS  Google Scholar 

  11. Ost L, Groth C-L, Lindholm B, Lundgren G, Magnusson G, Tillegard A. Cadaveric renal transplantation in patients of 60 years and above. Transplantation 1980; 30(5): 339–340.

    PubMed  CAS  Google Scholar 

  12. Pirsch JD, Stratta RJ, Armbrust MJ et al. Cadaveric renal transplantation with cyclosporine in patients more than 60 years of age. Transplantation 1989; 47(2): 259–261.

    PubMed  CAS  Google Scholar 

  13. Fehrman I, Brattstrom C, Duraj F, Groth CJ. Kidney transplantation in patients between 65 and 75 years of age. Transplantation Proceedings 1989; 21(1): 2018–2019.

    PubMed  CAS  Google Scholar 

  14. Howard RJ, Pfaff WW, Scornik JC et al. Kidney transplantation in older patients. Clin Transplantation 1990; 4: 181–186.

    Google Scholar 

  15. Andreu J, de la Torre M, Oppenheimer F et al. Renal transplantation in elderly recipients. Transplantation Proceedings 1992; 24(1): 120–121.

    PubMed  CAS  Google Scholar 

  16. Andreu J, Campistol JM, Oppenheimer F et al. Improved results in elderly renal transplants without prophylactic steroids. Clin Transplantation 1991; 5: 3–6.

    Google Scholar 

  17. Murie JA, Lauffer G, Gray D, Ting A, Morris PJ. Renal transplantation in the older patient. Transplantation Proceedings 1989; 21(1): 2024–2025.

    PubMed  CAS  Google Scholar 

  18. Howard RJ, Pfaff WW, Salomon D et al. Kidney transplantation in older patients. Transplantation Proceedings 1989; 21(1): 2020–2021.

    PubMed  CAS  Google Scholar 

  19. Barry JM, Lemmers MJ, Meyer MM et al. Cadaver kidney transplantation in patients more than 65 years old. World J Urology 1996; 14(4): 243–248.

    CAS  Google Scholar 

  20. Nyberg G, Nilsson B, Hallste G et al. Renal transplantation in elderly patients: Survival and complications. Transplantation Proceedings 1993; 25(1): 1062–1063.

    PubMed  CAS  Google Scholar 

  21. Penn I. Renal transplantation in the elderly. Transplantation and Immunology Letter 1997; 13(1): 11–12.

    Google Scholar 

  22. Winchester JF, Rakowski TA. End-stage renal disease and its management in older adults. Clinics in Geriatric Medicine 1998; 14(2): 255–265.

    PubMed  CAS  Google Scholar 

  23. Becker BN, Ismail N, Becker YT, MacDonnell RC, Helderman JH. Renal transplantation in the older end stage renal disease patient. Seminars in Nephrology 1996; 16(4): 353–362.

    PubMed  CAS  Google Scholar 

  24. Le A, Wilson R, Douek K et al. Prospective risk stratification in renal transplant candidates for cardiac death. Am J Kid Dis 1994; 24(1): 65–71.

    PubMed  CAS  Google Scholar 

  25. Mcfalls EO, Doliszny KM, Grund F, Chute E, Chesler E. Angina and persistent exercise thallium defects: Independent risk factors in elective vascular surgery. J Am Coll Cardiology 1993; 21(6): 1347–1352.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery Bronx Lebanon Medical Center, Bronx, New York, USA

    Amit Basu & Paul Gerst

  2. Department of Surgery Montefiore Medical Center, Bronx, New York, USA

    Stuart M. Greenstein, Suzanne Clemetson, Melinda Mallis, Dean Kim, Richard Schechner & Vivian A. Tellis

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  1. Amit Basu
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  2. Stuart M. Greenstein
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  3. Suzanne Clemetson
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  4. Melinda Mallis
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  6. Richard Schechner
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  7. Paul Gerst
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  8. Vivian A. Tellis
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Basu, A., Greenstein, S.M., Clemetson, S. et al. Renal transplantation in patients above 60 years of age in the modern era: A single center experience with a review of the literature. Int Urol Nephrol 32, 171–176 (2000). https://doi.org/10.1023/A:1007100306404

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