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Review
. 2009 Nov;29(6):621-35.
doi: 10.1016/j.semnephrol.2009.07.011.

Kidney transplantation in the elderly

Edmund Huang  1 , Dorry L Segev, Hamid Rabb
Affiliations
Review

Kidney transplantation in the elderly

Edmund Huang et al. Semin Nephrol. 2009 Nov.

Abstract

There is an increase in the older incident end-stage renal disease population that is associated with an increasing prevalence of end-stage renal disease in the United States. This trend is paralleled by an increasing rate of kidney transplantation in the elderly. Although patient survival is lower in older versus younger kidney recipients, the elderly benefit from a reduction in mortality rate and improved quality of life with transplantation compared with dialysis. Immunologic, physiologic, and psychosocial factors influence transplant outcomes and should be recognized in the care of the elderly transplant patient. In this review, we discuss transplantation in the elderly patient, particularly the topics of access to transplantation, patient and graft survival, the impact of donor quality on transplant outcomes, immunology and immunosuppression of aging, and ethical considerations in the development of an equitable organ allocation scheme.

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Figures

Figure 1
Figure 1
Incidence and prevalence rates of ESRD in the United States from 1980 to 2006. Adapted from the US Renal Data System, USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2008. The data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the US government.
Figure 2
Figure 2
Incident ESRD and kidney transplant counts in patients older than age 65 from 1990 to 2006 in the United States. Adapted from the US Renal Data System, USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2008. The data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the US government.
Figure 3
Figure 3
The association of age on (A) cardiovascular and (B) infection-related mortality in wait-listed (gray bars) and transplant patients (black bars). Reprinted with permission from Meier-Kriesche et al.
Figure 4
Figure 4
Causes of first-year mortality among renal transplant recipients older than age 60 in the United States. Adapted from Kauffman et al.
See this image and copyright information in PMC

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References

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