The evolving challenge of evaluating older renal transplant candidates

The demographic factor over age 65 years represents the fastest growing segment of the end-stage kidney disease, wait-listed for kidney transplant, and transplanted populations. As a result, transplant physicians are increasingly asked to evaluate candidacy in older patients. Relatively little attention has been paid to the unique aspects of the pretransplant evaluation in older persons. The natural tendency is to focus on individual comorbidities as isolated entities, such as a history of coronary heart disease, while ignoring factors more specific to the aging process itself. Assessment of the burden of comorbidity along with the application of standardized geriatric assessment tools, such as the measurement of physical and cognitive function, has the potential to refine the pretransplant evaluation process in older kidney transplant candidates.