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
. 2022 Dec;36(12):e14813.
doi: 10.1111/ctr.14813. Epub 2022 Sep 28.

Utility of geriatric assessments in evaluation of older adults for kidney transplantation

Kellie H Campbell  1 , Daniel J Ahn  2 , Frances Enger  3 , Lindsay Zasadzinski  3 , Jacob Tanumihardjo  3 , Yolanda Becker  4 , Michelle Josephson  5 , Milda R Saunders  3
Affiliations

Utility of geriatric assessments in evaluation of older adults for kidney transplantation

Kellie H Campbell et al. Clin Transplant. 2022 Dec.

Abstract

Background: While kidney transplantation has favorable outcomes in patients aged 65 years and older, many are not referred for evaluation despite having no contraindications. We wanted to determine whether incorporating geriatrics and geriatric assessments (GA), as part of kidney transplant evaluation at the University of Chicago Medicine, would help identify suitable candidates and improve transplantation outcomes among older adults.

Methods: Between 2012 and 2016, as part of their multi-disciplinary transplant evaluation, 171 patients underwent an initial GA with the study geriatrician, who rated them on a five-point scale from "poor" to "excellent," and presented their cases to multidisciplinary transplant review meetings. Patients were followed until June 1st, 2021. Predictor variables included geriatric recommendation, clinical characteristics, and demographics. Outcomes of interest were mortality, receipt of transplant, and waitlist placement.

Results: Compared to patients rated "poor," "marginal," or "fair," we found that patients that the geriatrician recommended as "good" or "excellent" were more likely to be waitlisted and receive a transplant. Favorably rated patients were also less likely to be removed from the waitlist due to becoming medically unfit, meaning worsening medical morbidity, frailty, and cognitive status.

Conclusion: Including geriatricians to perform GAs as part of the transplant evaluation process can help identify suitable elderly candidates.

Keywords: older adults; transplant access; transplant evaluation.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of overall kidney transplant evaluation.
FIGURE 2
FIGURE 2
Flow diagram of study participants from geriatric assessment.
FIGURE 3
FIGURE 3
Survival post‐deceased donor kidney transplant, N = 26.
FIGURE 4
FIGURE 4
Overall patient survival after initial geriatric evaluation (N = 171).
FIGURE 5
FIGURE 5
Cumulative incidence of waitlist removal since initial waitlist date, stratified by geriatric recommendation (N = 122).
See this image and copyright information in PMC

References

    1. 2020 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States . National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2020.
    1. Hernández D, Alonso‐Titos J, Armas‐Padrón AM, et al. Mortality in elderly waiting‐list patients versus age‐matched kidney transplant recipients: where is the risk? KBR. 2018; 43(1): 256‐275. 10.1159/000487684 - DOI - PubMed
    1. Sørensen SS. Rates of renal transplantations in the elderly—data from Europe and the US. Transplant Rev. 2015; 29(4): 193‐196. 10.1016/j.trre.2015.04.005 - DOI - PubMed
    1. Sørensen VR, Heaf J, Wehberg S, Sørensen SS. Survival benefit in renal transplantation despite high comorbidity. Transplantation. 2016; 100(10): 2160‐2167. 10.1097/TP.0000000000001002 - DOI - PMC - PubMed
    1. Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK. Renal transplantation in elderly patients older than 70 years of age: results from the scientific registry of transplant recipients. Transplantation. 2007; 83(8): 1069‐1074. 10.1097/01.tp.0000259621.56861.31 - DOI - PubMed

Publication types