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Immunosuppressive Therapy for Elderly Kidney Transplant Recipients
H Iwamoto1, Y Nakamura1, O Konno1
1Tokyo Medical University Hachioji Medical Center, Department of Digestive and Transplantation Surgery, Tokyo, Japan.
Transplantation Proceedings
|May 29, 2016
Summary
Elderly kidney transplant recipients aged 60 and over experienced acceptable outcomes, with no significant differences in acute rejection or graft survival rates compared to younger patients. Immunosuppressive drug doses were adjusted, showing favorable results for this demographic.
Area of Science:
- Nephrology
- Transplantation Immunology
- Geriatric Medicine
Background:
- Elderly kidney transplant (KT) recipients face increased risks of fatal infections, yet no age limits are established for KT.
- Determining suitability for KT in older adults is challenging due to varied health statuses.
Purpose of the Study:
- To evaluate the outcomes of elderly KT recipients (≥60 years) compared to non-elderly recipients (<59 years).
- To assess the safety and efficacy of a standard immunosuppressive protocol in older KT patients.
Main Methods:
- Retrospective analysis of 127 KT patients (24 elderly, 103 non-elderly) over 3 years post-transplant.
- Comparison of acute rejection, infection rates, immunosuppressive drug doses, renal function, and survival between age groups.
- Standard immunosuppression: calcineurin inhibitor, methylprednisolone, mycophenolate mofetil, and basiliximab.
Main Results:
- No significant differences in tacrolimus/cyclosporine doses or trough levels between groups.
- Lower mean mycophenolate mofetil dose in the elderly group at 1 year.
- Similar incidences of cytomegalovirus infection and acute rejection.
- Comparable graft survival rates: 100% (elderly) vs. 98.1% (non-elderly) at 1 year; 95.4% vs. 92.5% at 5 years.
- No significant differences in creatinine levels.
Conclusions:
- The current immunosuppressive protocol yields acceptable outcomes for elderly kidney transplant recipients.
- Age ≥60 years does not appear to be a contraindication for KT with this regimen.
- Further research may refine immunosuppression strategies for geriatric KT patients.
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