Deceased Donor Kidney Transplantation in Patients Aged 70 and Older: Is 70 the New 50?
Umar Faroo1, Yousef Al-Shraideh1, Alan C Farney1, Amudha Palanisamy2, Jeffrey Rogers1, Giuseppe Orlando1, Amber Reeves-Daniel2, William Doares3, Scott Kaczmorski3, Hany El-Hennawy1, Muhammad Khan1, Michael D Gautreaux4, Samy S Iskandar4, Gloria Hairston1, Elizabeth Brim1 and Robert J Stratta1*
- *Corresponding Author:
- Robert J Stratta
Department of Surgery
Wake Forest School of Medicine
Winston Salem, NC 27157, USA
E-mail: [email protected]
Received date: June 22, 2016; Accepted date: July 07, 2016; Published date: July 11, 2016
Citation: Faroo U, Al-Shraideh Y, Farney AC, Palanisamy A, Rogers J, et al. (2016) Deceased Donor Kidney Transplantation in Patients Aged 70 and Older: Is 70 the New 50?. J Gerontol Geriatr Res 5: 324. doi:10.4172/2167-7182.1000324
Copyright: © 2016 Faroo U, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction H2O in any medium, provided the original author and source are credited.
Background: Deceased donor (DD) kidney transplantation (KT) outcomes in patients who are aged 70 years and older are understudied.
Methods: We retrospectively reviewed our single center DD KT outcomes in patients aged 70 years and older. All patients received antibody induction with tacrolimus, half-dose mycophenolate, ± steroids. Results: Over 10.75 years, we performed 114 KTs in 112 patients aged 70 and older (mean 73.8, range 70-84 years) including 42 patients who were aged 75 and older. The study group included 60 males/52 females and 79 Caucasians/28 African Americans/5 other with a mean waiting time of 16 months; 75 patients (66%) received kidneys from expanded criteria donors (ECDs) and 14 received dual KTs. Delayed graft function occurred in 27% and influenced graft but not patient survival. With a mean follow-up of 68 months, patient survival was 59% and uncensored kidney graft survival was 47%. Three year and death-censored kidney graft survival rates were 76% and 74%, respectively. Outcomes were similar in patients < or ≥ 75 years. Of 60 graft losses, death with a functioning graft (DWFG) accounted for 41 (68%). Of 46 deaths, 72% were due to cardio/cerebrovascular events, infection, or malignancy. At present, 54 of the 66 surviving patients (81.8%) have functioning grafts. The incidences of acute rejection and major infection were 14% and 45%, respectively.
Conclusions: Advanced recipient age has a modest effect on medium-term outcomes in appropriately selected elderly patients using predominantly ECD kidneys, which may not be appropriate for younger patients. However, medium-term outcomes are largely influenced by a higher incidence of DWFGs in the elderly, suggesting that matching strategies for kidney and patient longevity are warranted.