老年学与老年病学研究

抽象的

Deceased Donor Kidney Transplantation in Patients Aged 70 and Older: Is 70 the New 50?

Umar Farooq, Yousef Al-Shraideh, Alan C Farney, Amudha Palanisamy, Jeffrey Rogers, Giuseppe Orlando, Amber Reeves-Daniel, William Doares, Scott Kaczmorski, Hany El-Hennawy, Muhammad Khan, Michael D Gautreaux, Samy S Iskandar, Gloria Hairston, Elizabeth Brim and Robert J Stratta*

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.