Journal Home
Search for

Volume 12, Issue 1, Pages 12-19 (April 2010)


View previous. 4 of 9 View next.

Outcomes of Renal Transplantation in Elderly Patients: Experience From Two Centers

Man-Wai LoaCorresponding Author Informationemail address, Siu-Ka Makb, Matthew K.L. Tongc, Hilda W.H. Chanc, Samuel K.S. Fungc, Hon-Lok Tangc, Yuk-Yi Wongb, Kwok-Chi Lob, Shuk-Fan Chanb, Gensy M.W. Tongb, Kin-Yee Lob, Ping-Nam Wongb, Andrew K.M. Wongb

Background

Elderly patients are the fastest growing age group in end-stage renal failure. Data from overseas show that transplantation is a safe and reliable mode of treatment for this group of patients. However, local data about the outcome in these patients are lacking. The aim of this study was to determine and compare the outcomes of renal transplantation among elderly recipients and younger recipients.

Methods

Using the Organ Registry and Transplant System in Kwong Wah Hospital and Princess Margaret Hospital, adult patients who had undergone renal transplantation and who had been followed-up by the two medical units were recruited. They were divided into the control group (age < 60) and the elderly group (age ≥ 60) according to age at transplantation. The following data were collected for cross-sectional analysis: comorbid illnesses, transplantation details, immunosuppressive therapy, incidence and severity of acute rejections, incidence of infection and malignancy, graft and patient survival, and causes of graft loss and death.

Results

A total of 324 episodes of transplantation were recorded (266 controls and 58 elderly). The incidence of acute rejection was higher in the control group (18% vs. 8.6%, p = 0.08). There was a trend towards higher incidence of infection and malignancy in the elderly group, though the difference did not reach statistical significance. The graft survival rate was similar in the two groups, while the 5-year patient survival rate was worse in the elderly group (92.1% vs. 79.3%, p = 0.0058).

Conclusion

The transplantation outcomes in elderly recipients are satisfactory, and age per se should not be considered a contraindication to transplantation.

No full text is available. To read the body of this article, please view the PDF online.

Article Outline

Abstract

References

Copyright

References 

return to Article Outline

1. 1 Census and Statistical Department  . Statistical Table. Population by Age Group, 1996, 2001 and 2006 . Available at http://www.censtatd.gov.hk/hong_kong_statistics/statistical_tables/index_t.jsp?charsetID=1&subjectID=1&tableID=137 [Date accessed: March 15, 2007] .

2. 2 Ho YW , Chau KF , Leung CB , Choy BY , Tsang WK , Wong PN , et al.   Hong Kong Registry Report 2004 . Hong Kong J Nephrol . 2005;7:38–46 .

3. 3 Wolfe RA , Ashby UB , Milford EL , Ojo AO , Ettenger RE , Agodoa LY , et al.   Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation and recipients of a first cadaveric transplant . N Engl J Med . 1999;341:1725–1730 . MEDLINE | CrossRef

4. 4 Cameron JI , Whiteside C , Katz J , Devins GM . Differences in quality of life across renal replacement therapies: a meta-analytic comparison . Am J Kidney Dis . 2000;35:629–637 . Abstract | Full Text | Full-Text PDF (49 KB) | CrossRef

5. 5 Winkelmayer WC , Weinstein MC , Mittleman MA , Glynn RJ , Pliskin JS . Health economic evaluations: the special case of end-stage renal disease treatment . Med Decis Making . 2002;22:417–430 . CrossRef

6. 6 Ismail N , Hakim RM , Helderman JH . Renal replacement therapies in the elderly: Part II. Renal transplantation . Am J Kidney Dis . 1994;23:1–15 . Abstract

7. 7 Doyle SE , Matas AJ , Gillingham K , Rosenberg ME . Predicting clinical outcome in the elderly renal transplant recipient . Kidney Int . 2000;57:2144–2150 . MEDLINE | CrossRef

8. 8 Meier-Kriesche HU , Ojo A , Hanson J , Cibrik D , Lake K , Agodoa LY , et al.   Increased immunosuppressive vulnerability in elderly renal transplant recipients . Transplantation . 2000;69:885–889 . MEDLINE

9. 9 Oniscu GC , Brown H , Forsythe JL . How old is old for transplantation? . Am J Transplant . 2004;4:2067–2074 . MEDLINE | CrossRef

10. 10 Friedman AL , Goker O , Kalish MA , Basadonna GP , Kliger AS , Bia MJ , et al.   Renal transplant recipients aged over 60 have diminished immune activity and a low risk of rejection . Int Urol Nephrol . 2004;36:451–456 . MEDLINE | CrossRef

11. 11 Wick G , Grubeck-Loebenstein B . The aging immune system: primary and secondary alterations of immune reactivity in the elderly . Exp Gerontol . 1997;32:401–413 . MEDLINE | CrossRef

12. 12 Hodes JR . Molecular alterations in the aging immune system . J Exp Med . 1995;182:1–3 . MEDLINE | CrossRef

13. 13 Globerson A . T lymphocytes and aging . Int Arch Allergy Immunol . 1995;107:491–497 . MEDLINE | CrossRef

14. 14 Trouillhet I , Benito N , Cervera C , Rivas P , Cofán F , Almela M , et al.   Influence of age in renal transplant infections: cases and controls study . Transplantation . 2005;80:989–992 . MEDLINE | CrossRef

15. 15 Moreso F , Ortega F , Mediluce A . Recipient age as a determinant factor of patient and graft survival . Nephrol Dial Transplant . 2004;19(Suppl 3):16–20 .

16. 16 Fishman JA , Emery V , Freeman R , Pascual M , Rostaing L , Schlitt HJ , et al.   Cytomegalovirus in transplantation—challenging the status quo . Clin Transplant . 2007;21:149–158 . MEDLINE | CrossRef

17. 17 Imao T , Ichimaru N , Takahara S , Kokado Y , Okumi M , Imamura R , et al.   Risk factors for malignancy in Japanese renal transplant recipients . Cancer . 2007;109:2109–2115 .

18. 18 Burns EA , Leventhal EA . Aging, immunity, and cancer . Cancer Control . 2000;7:513–522 . MEDLINE

19. 19 Muller AM , Ihorst G , Mertelsmann R , Engelhardt M . Epidemiology of non-Hodgkin's lymphoma: trends, geographic distribution, and etiology . Ann Hematol . 2005;84:1–12 . MEDLINE | CrossRef

20. 20 Cameron JS . Renal transplantation in the elderly . Int Urol Nephrol . 2000;32:193–201 . MEDLINE | CrossRef

21. 21 Opelz G . Factors influencing kidney graft survival in Latin America. Collaborative Transplant Study . Transplant Proc . 1999;31:2951–2954 . Full Text | Full-Text PDF (163 KB) | CrossRef

22. 22 United States Renal Data System  . Annual Data Report 1996 and Reference Tables . Available at http://www.usrds.org/adr_1996.htm [Date accessed: March 15, 2007] .

23. 23 United States Network for Organ Sharing and Division of Organ Transplantation 1994 Report (1988–1993) . Bethesda, MD: Bureau of Health Services Development, US Department of Health and Human Services; 1994; .

24. 24 Belger M . UK Transplant Services Special Authority Newsletter . Bristol: UKTSSA; 1998; .

25. 25 United States Renal Data System  . Annual Data Report 2006 Reference Tables . Available at http://www.usrds.org/reference.htm [Date accessed: March 15, 2007] .

26. 26 Raviňa FO , Martinez MR , Gude F , González-Juanatey JR , Valdés F , Sánchez-Guisande D . Renal transplantation in elderly: does patient age determine results? . Age Aging . 2005;34:583–587 .

27. 27 Humar A , Denny R , Matas AJ , Najarian JS . Graft and quality of life outcomes in older recipients of a kidney transplant . Exp Clin Transplant . 2003;1:69–72 . MEDLINE

28. 28 Pugliese O , Quintieri F , Mattucci DA , Venettoni S , Taioli E , Costa AN . Kidney graft survival in Italy and factors influencing it . Prog Transplant . 2005;15:385–391 . MEDLINE

29. 29 Zhou YC , Cecka JM . Effect of HLA matching on renal transplant survival . Clin Transpl . 1993;499–510 .

30. 30 Giblin L , Hollander M , Little D , Hickey D , Donohoe J , Walshe JJ , et al.   Renal transplantation in the elderly—the Irish experience . Ir J Med Sci . 2005;174:9–13 . MEDLINE | CrossRef

31. 31 Johnson DW , Herzig K , Purdie D , Brown AM , Rigby RJ , Nicol DL , et al.   A comparison of the effects of dialysis and renal transplantation on the survival of older uremic patients . Transplantation . 2000;69:794–799 . MEDLINE

32. 32 Bonal J , Cleris M , Vela E . Transplantation versus haemodialysis in elderly patients . Nephrol Dial Transplant . 1997;12:261–264 . MEDLINE | CrossRef

33. 33 Gill JS , Abichandani R , Kausz AT , Pereira BJ . Mortality after kidney transplant failure: the impact of non-immunologic factors . Kidney Int . 2002;62:1875–1883 . MEDLINE | CrossRef

34. 34 Jassal JV , Opeltz G , Cole E . Transplantation in the elderly: a review . Geriatr Nephrol Urol . 1997;7:157–165 . MEDLINE | CrossRef

a Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, Kowloon, Hong Kong SAR

b Renal Unit, Department of Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong SAR

c Department of Medicine and Geriatrics, Princess Margaret Hospital, Kowloon, Hong Kong SAR

Corresponding Author InformationCorrespondence to: Dr. Lo Man-Wai, Department of Medicine and Geriatrics, Our Lady of Maryknoll Hospital, 118 Shatin Pass Road, Wong Tai Sin, Kowloon, Hong Kong SAR. Fax: (+ 852) 23542221

PII: S1561-5413(10)60004-X

doi:10.1016/S1561-5413(10)60004-X


View previous. 4 of 9 View next.