Elderly Transplant Recipients

  • Aaron M. Winnick
  • Ilhan Karabicak
  • Dale A. Distant


While the total number of organs transplanted in this country has increased over the years, there is still an ever-widening gap between the need for organs and our capacity to meet that need as the overall waiting list continues to grow. This is due in part to significant advances in transplant techniques and outcomes such that Americans with organ failure now seek transplants in greater numbers. Additionally, life-expectancy gains in the United States are creating an aging population who are more likely to suffer organ failure than younger Americans. The national transplant waiting list has continued to shift toward older candidates. The Scientific Registry of Transplant Recipients (SRTR) reported that at the end of 2007, 59.7% of all 97,248 candidates on the waiting list for all organs were 50 years old or older, and 14.9% were 65 years or older. These percentages are substantially higher than they were in 1998 (41.5 and 8.1%, respectively) [1].


Transplant Recipient Acute Rejection Lung Transplantation Calcineurin Inhibitor Bronchiolitis Obliterans Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1998–2007. U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, Rockville, MDGoogle Scholar
  2. 2.
    U.S. Renal Data System, USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MDGoogle Scholar
  3. 3.
    Cameron JI, Whiteside C, Katz J et al (2000) Differences in quality of life across renal replacement therapies: a meta-analytic comparison. Am J Kidney Dis 35(4):629–637PubMedCrossRefGoogle Scholar
  4. 4.
    Wolfe RA, Ashby VB, Milford EL et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341(23):1725–1730PubMedCrossRefGoogle Scholar
  5. 5.
    Oniscu GC, Brown H, Forsythe JL (2004) How old is old for transplantation? Am J Transplant 4(12):2067–2074PubMedCrossRefGoogle Scholar
  6. 6.
    Fabrizii V, Winkelmayer WC, Klauser R et al (2004) Patient and graft survival in older kidney transplant recipients: does age matter? J Am Soc Nephrol 15(4):1052–1060PubMedCrossRefGoogle Scholar
  7. 7.
    Albrechtsen D, Leivestad T, Sodal G et al (1995) Kidney transplantation in patients older than 70 years of age. Transplant Proc 27(1):986–988PubMedGoogle Scholar
  8. 8.
    Rao PS, Merion RM, Ashby VB et al (2007) Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation 83(8):1069–1074PubMedCrossRefGoogle Scholar
  9. 9.
    Palomar R, Ruiz JC, Zubimendi JA et al (2002) Acute rejection in the elderly recipient: influence of age in the outcome of kidney transplantation. Int Urol Nephrol 33(1):145–148PubMedCrossRefGoogle Scholar
  10. 10.
    Wu C, Shapiro R, Tan H et al (2008) Kidney transplantation in elderly people: the influence of recipient comorbidity and living kidney donors. J Am Geriatr Soc 56(2):231–238PubMedCrossRefGoogle Scholar
  11. 11.
    Port FK, Bragg-Gresham JL, Metzger RA et al (2002) Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation 74(9):1281–1286PubMedCrossRefGoogle Scholar
  12. 12.
    Moore PS, Farney AC, Sundberg AK et al (2007) Dual kidney transplantation: a case-control comparison with single kidney transplantation from standard and expanded criteria donors. Transplantation 83(12):1551–1556PubMedCrossRefGoogle Scholar
  13. 13.
    Steinman TI, Becker BN, Frost AE et al (2001) Guidelines for the referral and management of patients eligible for solid organ transplantation. Transplantation 71(9):1189–1204PubMedCrossRefGoogle Scholar
  14. 14.
    Bunnapradist S, Danovitch GM (2007) Evaluation of adult kidney transplant candidates. Am J Kidney Dis 50(5):890–898PubMedCrossRefGoogle Scholar
  15. 15.
    Kasiske BL, Cangro CB, Hariharan S et al (2001) The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant 1(Suppl 2):3–95PubMedGoogle Scholar
  16. 16.
    Knoll G, Cockfield S, Blydt-Hansen T et al (2005) Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ 173(10):S1–S25PubMedCrossRefGoogle Scholar
  17. 17.
    Smetana GW (1999) Preoperative pulmonary evaluation. N Engl J Med 340(12):937–944PubMedCrossRefGoogle Scholar
  18. 18.
    Maisonneuve P, Agodoa L, Gellert R et al (1999) Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 354(9173):93–99PubMedCrossRefGoogle Scholar
  19. 19.
    Penn I (1993) The effect of immunosuppression on pre-existing cancers. Transplantation 55(4):742–747PubMedCrossRefGoogle Scholar
  20. 20.
    Danovitch G, Savransky S (2006) Challenges in the counseling and management of older kidney transplant candidates. Am J Kidney Dis 47(4 Suppl 2):S86–S97PubMedCrossRefGoogle Scholar
  21. 21.
    Oniscu GC, Brown H, Forsythe JL (2004) How great is the survival advantage of transplantation over dialysis in elderly patients? Nephrol Dial Transplant 19(4):945–951PubMedCrossRefGoogle Scholar
  22. 22.
    Martins PN, Pratschke J, Pascher A et al (2005) Age and immune response in organ transplantation. Transplantation 79(2):127–132PubMedCrossRefGoogle Scholar
  23. 23.
    Danovitch GM, Gill J, Bunnapradist S (2007) Immunosuppression of the elderly kidney transplant recipient. Transplantation 84(3):285–291PubMedCrossRefGoogle Scholar
  24. 24.
    Bradley BA (2002) Rejection and recipient age. Transpl Immunol 10(2–3):125–132PubMedCrossRefGoogle Scholar
  25. 25.
    Johnson DW, Nicol DL, Preston JM et al (2003) Use of mycophenolate mofetil in immunosuppressive protocols in elderly renal transplant recipients. Transplantation 76(3):619PubMedCrossRefGoogle Scholar
  26. 26.
    Meier-Kriesche HU, Morris JA, Chu AH et al (2004) Mycophenolate mofetil vs. azathioprine in a large population of elderly renal transplant patients. Nephrol Dial Transplant 19(11):2864–2869PubMedCrossRefGoogle Scholar
  27. 27.
    Meier-Kriesche HU, Li S, Gruessner RW et al (2006) Immunosuppression: evolution in practice and trends, 1994-2004. Am J Transplant 6(5 Pt 2):1111–1131PubMedCrossRefGoogle Scholar
  28. 28.
    Shah T, Kasravi A, Huang E et al (2006) Risk factors for development of new-onset diabetes mellitus after kidney transplantation. Transplantation 82(12):1673–1676PubMedCrossRefGoogle Scholar
  29. 29.
    Arbogast H, Huckelheim H, Schneeberger H et al (2005) A calcineurin antagonist-free induction/maintenance strategy for immunosuppression in elderly recipients of renal allografts from elderly cadaver donors: long-term results from a prospective single centre trial. Clin Transplant 19(3):309–315PubMedCrossRefGoogle Scholar
  30. 30.
    Emparan C, Wolters H, Laukotter M et al (2004) Long-term results of calcineurin-free protocols with basiliximab induction in “old-to-old” programs. Transplant Proc 36(9):2646–2648PubMedCrossRefGoogle Scholar
  31. 31.
    Segoloni GP, Messina M, Squiccimarro G et al (2005) Preferential allocation of marginal kidney allografts to elderly recipients combined with modified immunosuppression gives good results. Transplantation 80(7):953–958PubMedCrossRefGoogle Scholar
  32. 32.
    Kauffman HM, McBride MA, Cors CS et al (2007) Early mortality rates in older kidney recipients with comorbid risk factors. Transplantation 83(4):404–410PubMedCrossRefGoogle Scholar
  33. 33.
    Bentas W, Jones J, Karaoguz A et al (2008) Renal transplantation in the elderly: surgical complications and outcome with special emphasis on the Eurotransplant Senior Programme. Nephrol Dial Transplant 23(6):2043–2051PubMedCrossRefGoogle Scholar
  34. 34.
    Kemmer N, Safdar K, Kaiser TE et al (2008) Liver transplantation trends for older recipients: regional and ethnic variations. Transplantation 86(1):104–107PubMedCrossRefGoogle Scholar
  35. 35.
    Hoshida Y, Ikeda K, Kobayashi M et al (1999) Chronic liver disease in the extremely elderly of 80 years or more: clinical characteristics, prognosis and patient survival analysis. J Hepatol 31(5):860–866PubMedCrossRefGoogle Scholar
  36. 36.
    Stieber AC, Gordon RD, Todo S et al (1991) Liver transplantation in patients over sixty years of age. Transplantation 51(1):271–273PubMedCrossRefGoogle Scholar
  37. 37.
    Pirsch JD, Kalayoglu M, D’Alessandro AM et al (1991) Orthotopic liver transplantation in patients 60 years of age and older. Transplantation 51(2):431–433PubMedCrossRefGoogle Scholar
  38. 38.
    Bromley PN, Hilmi I, Tan KC et al (1994) Orthotopic liver ­transplantation in patients over 60 years old. Transplantation 58(7):800–803PubMedGoogle Scholar
  39. 39.
    Bilbao I, Balsells J, Lazaro JL et al (1995) Liver transplantation in patients over 60 years of age. Transplant Proc 27(4):2337–2338PubMedGoogle Scholar
  40. 40.
    Garcia CE, Garcia RF, Mayer AD et al (2001) Liver transplantation in patients over sixty years of age. Transplantation 72(4):679–684PubMedCrossRefGoogle Scholar
  41. 41.
    Cross TJ, Antoniades CG, Muiesan P et al (2007) Liver transplantation in patients over 60 and 65 years: an evaluation of long-term outcomes and survival. Liver Transpl 13(10):1382–1388PubMedCrossRefGoogle Scholar
  42. 42.
    Safdar K, Neff GW, Montalbano M et al (2004) Liver transplant for the septuagenarians: importance of patient selection. Transplant Proc 36(5):1445–1448PubMedCrossRefGoogle Scholar
  43. 43.
    Lucey MR, Brown KA, Everson GT et al (1997) Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg 3(6):628–637PubMedCrossRefGoogle Scholar
  44. 44.
    Wiesner RH, McDiarmid SV, Kamath PS et al (2001) MELD and PELD: application of survival models to liver allocation. Liver Transpl 7(7):567–580PubMedCrossRefGoogle Scholar
  45. 45.
    Desai NM, Mange KC, Crawford MD et al (2004) Predicting ­outcome after liver transplantation: utility of the model for end-stage liver disease and a newly derived discrimination function. Transplantation 77(1):99–106PubMedCrossRefGoogle Scholar
  46. 46.
    Kuramitsu K, Egawa H, Keeffe EB et al (2007) Impact of age older than 60 years in living donor liver transplantation. Transplantation 84(2):166–172PubMedCrossRefGoogle Scholar
  47. 47.
    Keswani RN, Ahmed A, Keeffe EB (2004) Older age and liver transplantation: a review. Liver Transpl 10(8):957–967PubMedCrossRefGoogle Scholar
  48. 48.
    Carey WD, Dumot JA, Pimentel RR et al (1995) The prevalence of coronary artery disease in liver transplant candidates over age 50. Transplantation 59(6):859–864PubMedGoogle Scholar
  49. 49.
    Levy MF, Somasundar PS, Jennings LW et al (2001) The elderly liver transplant recipient: a call for caution. Ann Surg 233(1):107–113PubMedCrossRefGoogle Scholar
  50. 50.
    Herrero JI, Lucena JF, Quiroga J et al (2003) Liver transplant recipients older than 60 years have lower survival and higher incidence of malignancy. Am J Transplant 3(11):1407–1412PubMedCrossRefGoogle Scholar
  51. 51.
    Abt PL, Mange KC, Olthoff KM et al (2004) Allograft survival following adult-to-adult living donor liver transplantation. Am J Transplant 4(8):1302–1307PubMedCrossRefGoogle Scholar
  52. 52.
    Olthoff KM, Merion RM, Ghobrial RM et al (2005) Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg 242(3):314–323PubMedGoogle Scholar
  53. 53.
    Collins BH, Pirsch JD, Becker YT et al (2000) Long-term results of liver transplantation in older patients 60 years of age and older. Transplantation 70(5):780–783PubMedCrossRefGoogle Scholar
  54. 54.
    Emre S, Mor E, Schwartz ME et al (1993) Liver transplantation in patients beyond age 60. Transplant Proc 25(1 Pt 2):1075–1076PubMedGoogle Scholar
  55. 55.
    Filipponi F, Roncella M, Boggi U et al (2001) Liver transplantation in recipients over 60. Transplant Proc 33(1–2):1465–1466PubMedCrossRefGoogle Scholar
  56. 56.
    Rudich S, Busuttil R (1999) Similar outcomes, morbidity, and mortality for orthotopic liver transplantation between the very elderly and the young. Transplant Proc 31(1–2):523–525PubMedCrossRefGoogle Scholar
  57. 57.
    Adam R, McMaster P, O’Grady JG et al (2003) Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 9(12):1231–1243PubMedCrossRefGoogle Scholar
  58. 58.
    Gomez-Manero N, Herrero JI, Quiroga J et al (2001) Prognostic model for early acute rejection after liver transplantation. Liver Transpl 7(3):246–254PubMedCrossRefGoogle Scholar
  59. 59.
    Zetterman RK, Belle SH, Hoofnagle JH et al (1998) Age and liver transplantation: a report of the Liver Transplantation Database. Transplantation 66(4):500–506PubMedCrossRefGoogle Scholar
  60. 60.
    Shaw BW Jr (1994) Transplantation in the elderly patient. Surg Clin North Am 74(2):389–400PubMedGoogle Scholar
  61. 61.
    Taylor DO, Edwards LB, Mohacsi PJ et al (2003) The registry of the International Society for Heart and Lung Transplantation: ­twentieth official adult heart transplant report – 2003. J Heart Lung Transplant 22(6):616–624PubMedCrossRefGoogle Scholar
  62. 62.
    Blanche C, Blanche DA, Kearney B et al (2001) Heart transplantation in patients seventy years of age and older: a comparative analysis of outcome. J Thorac Cardiovasc Surg 121(3):532–541PubMedCrossRefGoogle Scholar
  63. 63.
    Zuckermann A, Dunkler D, Deviatko E et al (2003) Long-term survival (>10 years) of patients >60, years with induction therapy after cardiac transplantation. Eur J Cardiothorac Surg 24(2):283–291PubMedCrossRefGoogle Scholar
  64. 64.
    Demers P, Moffatt S, Oyer PE et al (2003) Long-term results of heart transplantation in patients older than 60 years. J Thorac Cardiovasc Surg 126(1):224–231PubMedCrossRefGoogle Scholar
  65. 65.
    Weiss ES, Nwakanma LU, Patel ND et al (2008) Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database. J Heart Lung Transplant 27(2):184–191PubMedCrossRefGoogle Scholar
  66. 66.
    Mehra MR, Kobashigawa J, Starling R et al (2006) 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 25(9):1024–1042PubMedCrossRefGoogle Scholar
  67. 67.
    Costanzo MR, Augustine S, Bourge R et al (1995) Selection and treatment of candidates for heart transplantation. A statement for health professionals from the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association. Circulation 92(12):3593–3612PubMedCrossRefGoogle Scholar
  68. 68.
    Halpern SD, Ubel PA, Caplan AL (2002) Solid-organ transplantation in HIV-infected patients. N Engl J Med 347(4):284–287PubMedCrossRefGoogle Scholar
  69. 69.
    Szlachcic J, Massie BM, Kramer BL et al (1985) Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol 55(8):1037–1042PubMedCrossRefGoogle Scholar
  70. 70.
    Likoff MJ, Chandler SL, Kay HR (1987) Clinical determinants of mortality in chronic congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy. Am J Cardiol 59(6):634–638PubMedCrossRefGoogle Scholar
  71. 71.
    Cohn JN, Johnson GR, Shabetai R et al (1993) Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation 87(6 Suppl):VI5–VI16PubMedGoogle Scholar
  72. 72.
    Aaronson KD, Schwartz JS, Chen TM et al (1997) Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 95(12):2660–2667PubMedCrossRefGoogle Scholar
  73. 73.
    Levy WC, Mozaffarian D, Linker DT et al (2006) The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 113(11):1424–1433PubMedCrossRefGoogle Scholar
  74. 74.
    O’Neill JO, Taylor DO, Starling RC (2004) Immunosuppression for cardiac transplantation – the past, present and future. Transplant Proc 36(2 Suppl):309S–313SPubMedCrossRefGoogle Scholar
  75. 75.
    Morgan JA, John R, Mancini DM et al (2004) Should heart ­transplantation be considered as a treatment option for patients aged 70 years and older? J Thorac Cardiovasc Surg 127(6):1817–1819PubMedCrossRefGoogle Scholar
  76. 76.
    Forni A, Faggian G, Chiominto B et al (2007) Heart transplantation in older candidates. Transplant Proc 39(6):1963–1966PubMedCrossRefGoogle Scholar
  77. 77.
    Nagendran J, Wildhirt SM, Modry D et al (2004) A comparative analysis of outcome after heart transplantation in patients aged 60 years and older: the University of Alberta experience. J Card Surg 19(6):559–562PubMedCrossRefGoogle Scholar
  78. 78.
    Marelli D, Kobashigawa J, Hamilton MA et al (2008) Long-term outcomes of heart transplantation in older recipients. J Heart Lung Transplant 27(8):830–834PubMedCrossRefGoogle Scholar
  79. 79.
    Villar E, Boissonnat P, Sebbag L et al (2007) Poor prognosis of heart transplant patients with end-stage renal failure. Nephrol Dial Transplant 22(5):1383–1389PubMedCrossRefGoogle Scholar
  80. 80.
    Roithmaier S, Haydon AM, Loi S et al (2007) Incidence of ­malignancies in heart and/or lung transplant recipients: a ­single-institution experience. J Heart Lung Transplant 26(8):845–849PubMedCrossRefGoogle Scholar
  81. 81.
    Christie JD, Edwards LB, Aurora P et al (2008) Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult lung and heart/lung transplantation report – 2008. J Heart Lung Transplant 27(9):957–969PubMedCrossRefGoogle Scholar
  82. 82.
    Charman SC, Sharples LD, McNeil KD et al (2002) Assessment of survival benefit after lung transplantation by patient diagnosis. J Heart Lung Transplant 21(2):226–232PubMedCrossRefGoogle Scholar
  83. 83.
    De Meester J, Smits JM, Persijn GG et al (2001) Listing for lung transplantation: life expectancy and transplant effect, stratified by type of end-stage lung disease, the Eurotransplant experience. J Heart Lung Transplant 20(5):518–524PubMedCrossRefGoogle Scholar
  84. 84.
    Orens JB, Estenne M, Arcasoy S et al (2006) International guidelines for the selection of lung transplant candidates: 2006 update – a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 25(7):745–755PubMedCrossRefGoogle Scholar
  85. 85.
    Wain JC, Wright CD, Ryan DP et al (1999) Induction immunosuppression for lung transplantation with OKT3. Ann Thorac Surg 67(1):187–193PubMedCrossRefGoogle Scholar
  86. 86.
    Brock MV, Borja MC, Ferber L et al (2001) Induction therapy in lung transplantation: a prospective, controlled clinical trial comparing OKT3, anti-thymocyte globulin, and daclizumab. J Heart Lung Transplant 20(12):1282–1290PubMedCrossRefGoogle Scholar
  87. 87.
    Trulock EP, Christie JD, Edwards LB et al (2007) Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult lung and heart-lung transplantation report – 2007. J Heart Lung Transplant 26(8):782–795PubMedCrossRefGoogle Scholar
  88. 88.
    Weiss ES, Merlo CA, Shah AS (2009) Impact of advanced age in lung transplantation: an analysis of United Network for Organ Sharing data. J Am Coll Surg 208(3):400–409PubMedCrossRefGoogle Scholar
  89. 89.
    Meyers BF, de la Morena M, Sweet SC et al (2005) Primary graft dysfunction and other selected complications of lung transplantation: a single-center experience of 983 patients. J Thorac Cardiovasc Surg 129(6):1421–1429PubMedCrossRefGoogle Scholar
  90. 90.
    Boehler A, Estenne M (2003) Post-transplant bronchiolitis obliterans. Eur Respir J 22(6):1007–1018PubMedCrossRefGoogle Scholar
  91. 91.
    Amital A, Shitrit D, Raviv Y et al (2006) Development of malignancy following lung transplantation. Transplantation 81(4):547–551PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Aaron M. Winnick
  • Ilhan Karabicak
  • Dale A. Distant
    • 1
  1. 1.Department of Transplant SurgerySUNY Downstate Medical CenterBrooklynUSA

Personalised recommendations