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Patient and Graft Survival in Older Kidney Transplant Recipients: Does Age Matter?

Veronika Fabrizii^*, Wolfgang C. Winkelmayer^||, Renate Klauser^*, Josef Kletzmayr^*, Markus D. Säemann^*, Rudolf Steininger, Reinhard Kramar, Walter H. Hörl^* and Josef Kovarik^*,

*Division of Nephrology and Dialysis, Department of Medicine III, and Division of Transplant Surgery, Department of Surgery, University of Vienna, and Division of Nephrology and Dialysis, Department of Internal Medicine, Wilhelminenspital der Stadt Wien, Vienna, Austrian Dialysis and Transplant Registry, Krankenhaus der Kreuzschwestern Wels, Wels, Austria; and ^||Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.

Correspondence to: Dr. Veronika Fabrizii, Division of Nephrology and Dialysis, Department of Internal Medicine III, Vienna Medical University, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Phone: +43-1-40400-4390; Fax: +43-1-40400-4392; E-mail: veronika.fabrizii{at}akh-wien.ac.at

ABSTRACT. An increasing gap between supply and demand of donor kidneys for transplantation exists. There is concern regarding the allocation of scarce organs to elderly patients, because the benefit obtained by the transplant may be less in elderly compared with younger recipients. It was the objective of this study to determine differences in patient and organ survival between organ recipients >65 yr and 50 to 64 yr of age at transplantation. A retrospective cohort of 627 patients >50 yr who received a kidney transplant between 1993 and 2000 was assembled. Detailed information on patient demographics, comorbidities, and immunological and donor characteristics was ascertained before transplantation. Five-year patient and graft survival were evaluated by Kaplan-Meier survival curves and multivariate Cox proportional-hazard models. Five-year patient mortality was similar between patients aged >65 and 60 to 64 at transplantation (relative risk [RR] = 1.07; 95% confidence interval [CI], 0.66 to 1.74). Patients aged 50 to 59 yr showed a clear trend toward lower 5-yr mortality (RR = 0.66; 95% CI, 0.43 to 1.03). Compared with patients >65 yr, 5-yr graft loss was not different in patients aged 60 to 64 (RR = 1.28; 95% CI, 0.82 to 2.02) or those aged 50 to 59 yr at transplantation (RR = 1.02; 95% CI, 0.68 to 1.53). After thorough control for confounding, 5-yr graft survival was not materially different by age group. Discrimination against older candidates for kidney transplantation on age-related grounds alone is not warranted.

This article has been cited by other articles:

				S. Bayat, M. Kessler, S. Briancon, and L. Frimat Survival of transplanted and dialysed patients in a French region with focus on outcomes in the elderly Nephrol. Dial. Transplant., January 1, 2010; 25(1): 292 - 300. [Abstract] [Full Text] [PDF]

				J. W. de Fijter and G. G. Persijn Age, the riddle of renal transplantation Nephrol. Dial. Transplant., November 1, 2005; 20(11): 2307 - 2310. [Full Text] [PDF]

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673