Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 May;25(5):1680-7.
doi: 10.1093/ndt/gfp681. Epub 2009 Dec 27.

Benefit of kidney transplantation beyond 70 years of age

Kristian Heldal  1 , Anders Hartmann, Diana C Grootendorst, Dinanda J de Jager, Torbjørn Leivestad, Aksel Foss, Karsten Midtvedt
Affiliations

Benefit of kidney transplantation beyond 70 years of age

Kristian Heldal et al. Nephrol Dial Transplant. 2010 May.

Abstract

Background: Kidney transplantation generally improves long-term survival in patients with end-stage renal disease. However, in patients older than 70 years of age, only limited data are available that directly compare the potential survival benefit of transplantation versus dialysis.

Methods: All patients aged above 70 years who started dialysis between 1990 and 2005 and were waitlisted for kidney transplantation were included in the study. They were categorized according to time periods of inclusion (1990-99 vs 2000-05). Survival rates of altogether 286 dialysis patients were analyzed with a Kaplan-Meier model, as well as with a time-dependent Cox model. Comparisons were made between those who received a transplant and those who did not, and further between the two time periods.

Results: Median age at inclusion was 73.6 years (interquartile range 72.3-75.6). Two hundred and thirty-three patients (81%) received a kidney transplant during follow-up. Transplant recipients experienced an increased mortality in the first year after transplantation when compared to waitlisted patients. Patients starting dialysis between 1990 and 1999 had no significant long-term benefit of transplantation; HR for death 1.01 (0.58-1.75). In contrast, there was a substantial long-term benefit of transplantation among those starting dialysis after 2000; HR for death 0.40 (0.19-0.83), P = 0.014.

Conclusions: Survival after kidney transplantation in patients over 70 years has improved during the last decade and offers a survival advantage over dialysis treatment. Our experience supports the use of kidney transplantation in this age group if an increased early post-operative risk is accepted. This transplant policy may be challenged for priority reasons.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival plot: survival of waitlisted patients and patients receiving a kidney transplant. Start of dialysis: 1990–2005. Patients were censored from the waitlist group at the time of transplantation.
Fig. 2
Fig. 2
Kaplan–Meier survival plot: survival of waitlisted patients and patients receiving a kidney transplant. Start of dialysis: 1990–99. Patients were censored from the waitlist group at the time of transplantation.
Fig. 3
Fig. 3
Kaplan–Meier survival plot: survival of waitlisted patients and patients receiving a kidney transplant. Start of dialysis: 2000–05. Patients were censored from the waitlist group at the time of transplantation.
Fig. 4
Fig. 4
Survival of kidney transplant recipients according to transplant era.
See this image and copyright information in PMC

References

    1. Jager KJ, van Dijk PC, Dekker FW, et al. The epidemic of aging in renal replacement therapy: an update on elderly patients and their outcomes. Clin Nephrol. 2003;60:352–360. - PubMed
    1. Macrae J, Friedman AL, Friedman EA, et al. Live and deceased donor kidney transplantation in patients aged 75 years and older in the United States. Int Urol Nephrol. 2005;37:641–648. - PubMed
    1. Port FK, Merion RM, Roys EC, et al. Trends in organ donation and transplantation in the United States, 1997–2006. Am J Transplant. 2008;8:911–921. - PubMed
    1. Danovitch GM, Cohen DJ, Weir MR, et al. Current status of kidney and pancreas transplantation in the United States, 1994–2003. Am J Transplant. 2005;5:904–915. - PubMed
    1. Organ by age. Organ Procurement and Transplantation. Network http://optn.transplant.hrsa.gov/latestData/viewDataReports.asp. Accessed 11 September 2009.

Publication types