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Transplantation in the elderly: a review
1Division of Nephrology, University of Toronto, Canada.
Geriatric Nephrology and Urology
|January 1, 1997
Summary
Renal transplantation in patients over 60 shows improved survival rates, with patient death being the primary cause of graft loss. Kidneys from older donors are viable options despite long-term outcome considerations.
Area of Science:
- Nephrology
- Transplantation Immunology
- Geriatric Medicine
Background:
- Renal transplantation is a crucial treatment for end-stage renal disease (ESRD).
- The aging population necessitates evaluating transplantation outcomes in older adults (≥60 years).
- The use of deceased donor kidneys, including those from older donors, is increasing due to organ shortages.
Purpose of the Study:
- To review current knowledge on patient and graft survival, complications, and management in renal transplant recipients aged 60 years or older.
- To evaluate the advantages and disadvantages of using deceased donor kidneys from older individuals.
Main Methods:
- Systematic literature review of published articles from 1976 to 1996 using MEDLINE.
- Inclusion of expert opinion and citations from existing review articles.
Main Results:
- Improved 5-year patient survival (54-75%) and graft survival (52-74%) in older recipients.
- Patient death, rather than rejection, is the main cause of graft loss in this age group.
- Older transplant recipients demonstrate a survival advantage compared to similar dialysis patients, even after comorbidity matching.
- Infectious complications and malignancy are the predominant post-transplant morbidities.
- Kidneys from older donors are utilized due to organ scarcity, though long-term outcomes may be less favorable.
- Insufficient data exists on optimal immunosuppression and age-matching strategies for older donor organs.
Conclusions:
- Renal transplantation is a viable option for patients aged 60 and above, with encouraging survival rates.
- While kidneys from older donors can be used, careful consideration of long-term outcomes is necessary.
- Further research is needed to optimize immunosuppression and donor-recipient matching protocols for elderly transplant recipients and older donor organs.