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Effect of age on the outcome of renal transplantation: A single-center experience.

Byline: Faruk Ozkul, Halil Erbis, Vural Taner Yilmaz, Huseyin Kocak, Ibrahim Ali Osmanoglu and Ayhan

ABSTRACT

Objectives: To analyze the effects of old age on renal transplantation (Tx) results and graft survival, and compared elderly patient population with the young patients.

Methods: A total of 1946 renal transplant were performed from 1537 living and 409 cadaveric donors between 2003 and 2014. The recipients were divided into two groups according to their age at the time of transplantation. The young age group consisted of 18-59-year-old, and the elderly group consisted of the ones [greater than or equal to] 60 years.

Results: Acute rejection was seen in 19.5% of the young age group while this rate was 16.7% in the old age group (p=0.535). DGF was seen in 6.3% of the young age group, and in 13.5% of the old age group (p<0.001). Analysis of the overall survival rates demonstrated that 1.6% of the patients in the young age group and 6.8% of the patients in the old age groups died (p=0.003).

Conclusions: Renal transplant had high graft survival rates in the elderly as in the young patients. However, the risks for complications were higher in the older age group compared to the younger age group. Thus, it is important to make a careful selection among elderly candidates for renal transplantation.

KEY WORDS: Age, Renal transplantation Survival.

INTRODUCTION

The number of the elderly patients with end-stage kidney disease who are candidates for renal transplantation (Tx) has been increasing as the world population gets older. In addition, elderly people have been increasingly act as donors owing to limited number of living and cadaver organ donors. Currently, old age has not been accepted as a contraindication for renal transplant. However, short life expectancy as well as higher rejection and medical complication rates related to comorbidities cause a bias for renal Tx in the elderly patients.

Various centers in the developed countries reported the results of renal transplant in the elderly in order to analyze the risks of elderly kidney donors and recipients better, and to determine the effects of age on graft survival.1-5 Although a clear consensus has not been reached, it has been currently supposed that renal Tx could be employed safely in selected elderly patients. However, we suppose that renal transplant results in the elderly patients should be analyzed before reaching this conclusion.

For this purpose, in this large single-center study, we analyzed the effects of old age on renal Tx results and graft survival, and compared elderly patient population with the young patients.

METHODS

Subjects: A total of 1946 renal transplant were performed from 1537 living and 409 cadaveric donors between January 2003 and June 2014 in our center. The recipients and living donors were divided into two groups according to their age at the time of transplantation. The young age group consisted of 18-59-year-old participants, and the elderly group consisted of the ones [greater than or equal to] 60 years of age. The exclusion criteria were the ones that had another organ transplant besides the kidney, and a pediatric age. The immunosuppression protocols were similar in two age groups.

We retrospectively reviewed the medical data of the donors including age, gender, body mass index (BMI), comorbidities, blood pressure, kidney size, serum creatinine level, and glomerular filtration rate (GFR). We also reviewed the data of the recipients regarding age, gender, primary renal disease, mean blood pressure, serum creatinine level, duration of dialysis, history of hypertension and/or diabetes, HLA haplotype matches, vascular anastomosis time, total surgical time, and surgical complications.

The mean follow-up period was 120.7+-24 months with a minimum period of 12 months. The data were collected 1, 6, and 12 months after transplantation, and included presence of delayed graft function (DGF), acute rejection episodes, total hospital stay, and the laboratory parameters. The primary endpoints were patient and graft survival. Graft failure was defined as return to dialysis. Death of the recipient was considered as the patient loss. DGF was defined as the need for dialysis within the first week after Tx. Donor follow-up data were also collected.

Statistical analysis: The statistical analyses were performed using SPSS for Windows, version 19.0. Chi-square test was used for univariate analysis of the categorical variables, and Mann-Whitney U test was used for the continuous variables. Graft and patient survivals were calculated with the Kaplan-Meier method. Logistic regression analysis was used to identify the risk factors associated with graft survival and patient outcomes. A p value smaller than 0.05 was considered as statistically significant.

RESULTS

Among 1946 Tx recipients, 1859 patients (95.5%) were younger than 60 years of age, and 87 patients (4.5%) were [greater than or equal to] 60 years of age. The mean age of elderly group was 63.7+-3.6 years, compared with 36.9+-11.3 years in the younger group. Seventy percent of the patients were males in the elderly group versus 67.3% in the younger group (p=0.590). The mean age of the donor group was 44.2+-12.5 (18 - 87) years. There were 1719 (88.3%) patients in 18 - 59 age group, and 227 (11.7%) patients [greater than or equal to] 60 years of age, and 48.6% of them were males and 51.4% were females.

There was no difference between young and old age groups for hospital stay (8.7+-6 vs 9.3+-4.2 days, p=0.053). Acute rejection was seen in 19.5% of the young age group while this rate was 16.7% in the old age group (p=0.535). DGF was seen in 6.3% of the young age group, and in 13.5% of the old age group (p<0.001). The creatinine levels measured 1, 6, and 12 months after Tx were similar in the young and old age groups (p=0.417, p=0.231, p=0.322; respectively). There was no difference between the young and old recipient age groups for graft survival rate, after a mean follow up period of 120 months (p=0.972; Fig.1).

Table-I: Patient characteristics and postoperative data.

###Age < 60 years###Age [greater than or equal to] 60 years###p value

No. patients (%)###1859 (95.5%)###87 (4.5%)

Mean recepient age +- SD, years###36.9+-11.3 years###63.7+-3.6 years

Recepient gender

Male / Female (%)###1252/607 (67.3%)###61/26 (70%)###0.590

Dialysis pretransplant (%)###82.4%###85.7%###0.748

Mean cold ischemia time (h)###3.2+-5.7###3.7+-5.7###0.687

Mean +- SD hospitalization time (days)###8.7+-6 days###9.3+-4.2###0.053

Mean +- SD serum creatinine 1 yr (mg/dL)###1.2+-0.6###1.3+-0.7###0.322

Acute rejection rate (%)###19.5%###16.7%###0.535

Delayed graft function rate (%)###6.3%###6.8%###70 years) does not affect graft survival in the medium term. Transplant Proc. 2010;42: 3935-3937. doi: 10.1016/j.transproceed.2010.08.069.

3. Kwon OJ, Kwak JY. The impact of sex and age matching for long-term graft survival in living donor renal transplantation. Transplant Proc. 2004;36: 2040-2042.

4. Ghafari A, Ardalan MR. Renal transplantation in elderly recipients: a single-center experience. Transplant Proc. 2008;40: 238-239.

5. Lai Q, Nudo F, Levi Sandri GB, Melandro F, Ferretti S, Grieco M, et al. Survival after kidney transplantation does not differ with 50-59-or over 60-year-old expanded-criteria donors. Transplant Proc. 2011;43: 1030-1032.

6. Saudan P, Berney T, Leski M, Morel P, Bolle JF, Martin PY. Renal transplantation in the elderly: a long-term single-centre experience. Nephrol Dial Transplant. 2001;16: 824-828.

7. Nanmoku K, Matsuda Y, Yamamato T, Tsujita M, Hiramitsu T, Goto N, et al. Clinical characteristics and outcomes of renal transplantation in elderly recipients. Transplant Proc. 2012;44: 281-283.

8. Ghafari A, Ardalan MR. Renal transplantation in elderly recipients: A single-center experience. Transplant Proc. 2008;40: 238-239.

9. Rodelo JR, Nieto-Rios JF, Serna-Higuita LM, Henao JE, Garcia A, Reino AC, et al. Survival of renal transplantation patients older than 60 years: A single-center experience. Transplant Proc. 2013;45: 1402-1409.

10. Bronzatto EJM, Silva Quadros KR, Santos RLS, Alves-Filho G, Mazzali M. Delayed graft function in renal transplant recipients: risk factors and impact on 1-year graft function: a single center analysis. Transplant Proc. 2009;41: 849-851.

11. Bardonnaud N, Pillot P, Lillaz J, Delorme G, Chabannes E, Bernardini S, et al. Outcomes of renal transplantation in obese recipients. Transplant Proc. 2012;44: 2787-2791.

12. Huang E, Segev DL, Rabb H. Kidney transplantation in the elderly. Seminars in Nephrology. 2009;29: 621-635.
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Publication:Pakistan Journal of Medical Sciences
Article Type:Report
Date:Aug 31, 2016
Words:1556
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