Kidney transplants from, to extreme elderly feasible in ESRD

Kidney transplantation among elderly people with end-stage renal disease (ESRD) can be successful, allowing them to live dialysis-free, according to a study recently published in Nephrology Dialysis Transplantation.

Jimena Cabrera, from Universidad de la Republica in Montevideo, Uruguay, and colleagues assessed outcomes of kidney transplantation in extremely elderly patients with ESRD based on an allocation policy prioritizing donor-recipient age matching. The analysis included 138 recipients ages ≥75 years who underwent kidney transplantation from similarly aged deceased donors between 2002 and 2015 with a median 38.8 months of follow-up.

The researchers reported that 22.5 percent of donors were ≥80 years. Eight percent of patients experienced primary graft nonfunction. The cumulative incidence rate was 70.3 percent for posttransplant infection and 15.2 percent forbiopsy-proven acute rejection (BPAR). One-year patient survival was 82.1 percent, while five-year patient survival was 60.1 percent. The corresponding rates for death-censored graft survival were 95.6 and 93.1 percent. The leading cause of death was infection (46.0 percent of fatal cases). There was an association noted between occurrence of BPAR and lower one-year patient survival (hazard ratio, 4.21). The only factor predicting five-year death-censored graft survival was diabetic nephropathy (hazard ratio, 4.82).

“ESRD patients ≥75 years can access kidney transplantation and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival,” conclude the authors.