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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...

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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
09:15

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Published on: May 7, 2019

Renal transplantation in the elderly.

Ramesh Saxena1, Xueqing Yu, Mauricio Giraldo

  • 1Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA. ramesh.saxena@utsouthwestern.edu

International Urology and Nephrology
|November 8, 2008
PubMed
Summary

Kidney transplants using expanded criteria donor (ECD) organs offer excellent outcomes, even for elderly recipients. Careful donor/recipient selection and optimized immunosuppression are key to managing risks like infection and malignancy in older transplant patients.

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Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Geriatric Medicine

Background:

  • Increasing prevalence of end-stage renal disease (ESRD) in aging populations worldwide.
  • Organ donor scarcity necessitates broader acceptance criteria for kidney transplantation.
  • Expanded criteria donor (ECD) kidneys, from older donors or those with comorbidities, are increasingly utilized.

Purpose of the Study:

  • To evaluate the outcomes of kidney transplantation using ECD organs in elderly patients.
  • To explore strategies for optimizing the use of ECD kidneys, including age-matching and pulsatile perfusion.
  • To address the unique challenges of immunosuppression in elderly transplant recipients.

Main Methods:

  • Review of outcomes utilizing ECD kidneys in elderly recipients.
  • Assessment of donor and recipient profiling and selection strategies.
  • Evaluation of pulsatile perfusion's role in ECD kidney utilization and decision-making.
  • Analysis of immunosuppressive strategies for elderly transplant recipients.

Main Results:

  • Excellent outcomes are achievable with ECD kidneys through careful donor and recipient selection.
  • Age-matching and pulsatile perfusion can optimize ECD organ utilization and improve outcomes.
  • Elderly recipients face higher risks of post-transplant infections and malignancy due to age-related immune dysfunction and comorbidities.

Conclusions:

  • Kidney transplantation with ECD organs is a viable option for elderly patients with ESRD.
  • Optimized donor/recipient selection, age-matching, and pulsatile perfusion enhance ECD kidney transplant success.
  • Careful management of immunosuppression is crucial to minimize complications and maximize long-term graft and patient survival in elderly recipients.