Comorbidities and kidney transplant evaluation in the elderly

Area of Science:

• Nephrology
• Transplantation Medicine
• Geriatrics

Background:

• End-stage renal disease (ESRD) is increasing among the elderly.
• This demographic represents the fastest-growing ESRD subpopulation.
• Transplant eligibility criteria for elderly patients require further definition.

Purpose of the Study:

• To characterize elderly patients (≥65 years) evaluated for kidney transplantation.
• To compare characteristics of elderly patients listed versus not listed for transplantation.
• To identify factors associated with transplant ineligibility in older adults.

Main Methods:

• Retrospective review of 123 elderly patients referred for transplant evaluation over 2 years.
• Comparison of demographic and clinical factors between listed and unlisted patients.
• Multivariable logistic regression to determine factors associated with waitlisting denial.

Main Results:

• 50% of elderly candidates were listed, compared to 75.4% of younger patients (<65 years).
• Older age, coronary artery disease, and poor mobility were independently associated with denial.
• The model demonstrated strong predictive accuracy for denial of listing (AUC = 0.88).

Conclusions:

• Elderly kidney transplant candidates have a high burden of comorbidities.
• More than half of evaluated elderly patients are unsuitable for waitlisting.
• Improved characterization of transplant suitability in the elderly is crucial for appropriate referrals and expectation management.