Kidney transplantation in the extremely elderly from extremely aged deceased donors: a kidney for each age
| Autor: | Enrique Morales, Alfredo Rodríguez-Antolín, Manuel Praga, Jimena Cabrera, Amado Andrés, Mario Fernández-Ruiz, Hernando Trujillo, Natalia Polanco, Maria Molina, Juan Rodríguez Mori, Alejandra Canon, Esther A. González, Eduardo Hernández, Eduardo Gutiérrez |
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| Rok vydání: | 2020 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology 030230 surgery 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Interquartile range Internal medicine medicine Humans Cumulative incidence Kidney transplantation Dialysis Aged Retrospective Studies Aged 80 and over Transplantation business.industry Proportional hazards model Graft Survival Hazard ratio Age Factors medicine.disease Kidney Transplantation Tissue Donors Nephrology Kidney Failure Chronic Female Hemodialysis business |
| Zdroj: | Nephrology Dialysis Transplantation. 35:687-696 |
| ISSN: | 1460-2385 0931-0509 |
| Popis: | BackgroundAdvances in life expectancy have led to an increase in the number of elderly people with end-stage renal disease (ESRD). Scarce information is available on the outcomes of kidney transplantation (KT) in extremely elderly patients based on an allocation policy prioritizing donor–recipient age matching.MethodsWe included recipients ≥75 years that underwent KT from similarly aged deceased donors at our institution between 2002 and 2015. Determinants of death-censored graft and patient survival were assessed by Cox regression.ResultsWe included 138 recipients with a median follow-up of 38.8 months. Median (interquartile range) age of recipients and donors was 77.5 (76.3–79.7) and 77.0 years (74.7–79.0), with 22.5% of donors ≥80 years. Primary graft non-function occurred in 8.0% (11/138) of patients. Cumulative incidence rates for post-transplant infection and biopsy-proven acute rejection (BPAR) were 70.3% (97/138) and 15.2% (21/138), respectively. One- and 5-year patient survival were 82.1 and 60.1%, respectively, whereas the corresponding rates for death-censored graft survival were 95.6 and 93.1%. Infection was the leading cause of death (46.0% of fatal cases). The occurrence of BPAR was associated with lower 1-year patient survival [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.64–10.82; P = 0.003]. Diabetic nephropathy was the only factor predicting 5-year death-censored graft survival (HR = 4.82, 95% CI 1.08–21.56; P = 0.040).ConclusionsESRD patients ≥75 years can access KT and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival. |
| Databáze: | OpenAIRE |
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