Kidney Transplantation in the Older Adult

被引:160
作者
Knoll, Greg A. [1 ,2 ]
机构
[1] Univ Ottawa, Ottawa Hosp, Res Inst, Div Nephrol,Kidney Res Ctr, Ottawa, ON, Canada
[2] Ottawa Hosp, Res Inst, Clin Epidemiol Program, Ottawa, ON K1H 7W9, Canada
关键词
Kidney transplantation; elderly; immunosuppression; organ donation; survival analysis; QUALITY-OF-LIFE; LIVING DONORS; RECIPIENT AGE; FRAILTY; DIALYSIS; MORTALITY; EXCHANGE; OUTCOMES; IMPACT;
D O I
10.1053/j.ajkd.2012.08.049
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
The end-stage renal disease population is aging. Nearly half of all new patients are older than 65 years and one third are older than 70 years. Assessing the possibility of transplantation for older patients with end-stage renal disease often involves contemplating more complex issues, including cognitive impairment, decreased functional status, and frailty, which makes selecting appropriate candidates more difficult. Older transplant recipients have decreased patient and transplant survival compared with younger recipients. For example, 75% of deceased donor transplant recipients aged 30-49 years are alive after 5 years compared to only 61% for those older than 65 years. Despite poorer outcomes compared with younger recipients, older transplant recipients have a significant improvement in survival compared with similar patients who remain on the wait list, with decreases in mortality of 41%-61% depending on the study. Use of living donors, even older living donors, provides significantly better outcomes for elderly recipients compared with the use of deceased donors. However, in the absence of a living donor, survival is improved significantly by accepting an expanded criteria donor organ rather than waiting for a standard criteria deceased donor. Older transplant recipients experience more infectious complications and less acute rejection, but the risk of transplant loss from rejection is increased compared with younger patients. These immunologic issues, along with the fact that older patients often are excluded from transplant trials, have made selecting an ideal immunosuppressive regimen challenging. Prospective comparative trials of different agents in the elderly population are warranted to better define the risk-benefit profile. This review discusses transplantation outcomes, including patient and transplant survival, different donor types, quality of life, and immunosuppression for older dialysis patients. Am J Kidney Dis. 61( 5): 790-797. (C) 2013 by the National Kidney Foundation, Inc.
引用
收藏
页码:790 / 797
页数:8
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