Int Urol Nephrol (2015) 47:1415–1422 DOI 10.1007/s11255-015-1034-9
NEPHROLOGY - ORIGINAL PAPER
Outcomes following renal transplantation in older renal transplant recipients: a single‑center experience and “Croatian senior program” I. Mikolasevic1,2 · S. Racki1,2 · J. Spanjol2,3 · Z. Zupan2,4 · I. Jakopcic2 · B. Devcic1 · L. Orlic1,2
Received: 20 March 2015 / Accepted: 11 June 2015 / Published online: 27 June 2015 © Springer Science+Business Media Dordrecht 2015
Abstract Background/objective Outcomes of kidney transplantation in older patients have not, however, been fully defined. The aims of this study were to analyze the number of new end-stage renal disease (ESRD) patients ≥65 years of age who were managed with kidney transplantation and their survival through the study period. In addition, we have analyzed post-transplantation outcomes in younger and older renal transplant recipients (RTRs). Methods We have analyzed the mean age of 505 RTRs transplanted between January 1990 and December 2013. Older people were defined as aging 65 years or older. Of 505 RTRs, there were 73 (14.5 %) patients who were ≥65 years of age. Therefore, in further analysis, patients were divided into two subgroups: younger recipients (younger than 65 years) and older recipients (aging 65 years or older). Results In the period from 1990 to 2001, patients who were 65 years of age and older were only sporadically treated with kidney transplantation in Croatia. Since 2002, the number of patients older than 65 years undergoing renal transplantation has been increasing. The older recipients * I. Mikolasevic [email protected]
were more likely to receive organs from older donors (52.6 ± 16.8 vs. 45.8 ± 13.2; p = 0.0001). There were no significant differences due to HLA mismatch between the two groups of analyzed patients. There was no difference in the rates of DGF between the older and younger recipients. Older recipients were less likely than younger recipients to have acute rejection crisis during the first-ear after transplantation (16.4 vs. 34.7 %; p = 0.03). There were no significant differences due to readmission rates in the firstyear post-transplantation between the two groups. There was no significant difference due to graft function and 1-year graft and patient’s survival between young and older recipients. Serum creatinine values at 1 year were higher in older recipients who received kidneys from elderly donor. Conclusion Our experience supports the use of kidney transplantation in the population of older ESRD patients. We can increase patients and graft survivals in elderly individuals with careful pre-transplant evaluation and HLA matching. “Croatian senior program” that includes HLA matching represents a good approach for kidney transplantation in older ESRD patients. Keywords Kidney transplantation · Elderly patients · Outcomes
L. Orlic [email protected]
Introduction
1
Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
2
School of Medicine, Rijeka, Croatia
3
Department of Urology, UHC Rijeka, Rijeka, Croatia
4
Department of Anesthesiology and Critical Care, UHC Rijeka, Rijeka, Croatia
Elderly patients are by far the fastest growing population that has a need for renal replacement therapy (RRT) worldwide [1]. Previous studies indicate that about half of the patients receiving RRT in the hemodialysis centers are aged 65 or over. The fast growth in the elderly population of patients primarily results from declines in fertility and mortality rates. Due to the increase in elderly individuals in the
13
1416
population pyramid worldwide, the incidence of chronic diseases (arterial hypertension, diabetes mellitus, coronary artery disease and heart failure) has also risen in the overall population. The rapid growth of the elderly ESRD patients has raised important issues regarding the choice of RRT in these populations of patients. Consequently, during the last decade, the age of patients awaiting kidney transplantation has been increasing. Kidney transplantation is the treatment option of RRT for most of the patients with end-stage renal disease (ESRD) without contraindications for transplantation and with respect to survival, quality of life and costs [2, 3]. Low survival rates and a low quality of life in patients who are treated with hemodialysis make kidney transplantation an attractive treatment option with good clinical results even in elderly recipients. It is generally assumed that older ESRD patients who undergo successful kidney transplantation gain a survival benefit in comparison with those who are treated with hemodialysis [1–5]. Kidney transplantation in elderly patients can be associated with some problems. Due to the widening gap between demand and supply of donor organs, kidney transplantation is rarely offered to older patients with ESRD. Therefore, access to kidney transplantation continues to be limited for older ESRD patients in many countries. Many clinicians consider hemodialysis as a stable strategy with an acceptable survival and few short-term risks. For example, authors from one Canadian study have reported that 26.5 % of patients who are 65 years or older and who have no contraindications to kidney transplantation were not referred for assessment [6]. When an elderly person faces the possibility of kidney transplantation, clinicians often have difficulties in making treatment decisions and must consider many aspects regarding the patient’s underlying condition and probable outcomes. On the basis of the available literature, due to the improving results of kidney transplantation, the impact of the recipient’s age on the short-term and long-term results of transplantation has been considerably reduced. Many authors argue that today age per se is no longer a contraindication to kidney transplantation [7–12]. According to these observations, the aims of this study were to analyze the number of new ESRD patients ≥65 years of age who were managed with kidney transplantation and their survival through the study period. In addition, we have analyzed post-transplantation outcomes in younger and older renal transplant recipients (RTRs).
Patients and methods Using a single-center, retrospective cohort study design (involving data collected prospectively for a purpose not directly related to the current study), we have analyzed 505 renal transplant recipients whose mean age was
13
Int Urol Nephrol (2015) 47:1415–1422
49.7 ± 13.5 years (309 males and 193 females) transplanted at the University Hospital Centre Rijeka between January 1990 and December 2013. Exclusion criteria were: age
NEPHROLOGY - ORIGINAL PAPER
Outcomes following renal transplantation in older renal transplant recipients: a single‑center experience and “Croatian senior program” I. Mikolasevic1,2 · S. Racki1,2 · J. Spanjol2,3 · Z. Zupan2,4 · I. Jakopcic2 · B. Devcic1 · L. Orlic1,2
Received: 20 March 2015 / Accepted: 11 June 2015 / Published online: 27 June 2015 © Springer Science+Business Media Dordrecht 2015
Abstract Background/objective Outcomes of kidney transplantation in older patients have not, however, been fully defined. The aims of this study were to analyze the number of new end-stage renal disease (ESRD) patients ≥65 years of age who were managed with kidney transplantation and their survival through the study period. In addition, we have analyzed post-transplantation outcomes in younger and older renal transplant recipients (RTRs). Methods We have analyzed the mean age of 505 RTRs transplanted between January 1990 and December 2013. Older people were defined as aging 65 years or older. Of 505 RTRs, there were 73 (14.5 %) patients who were ≥65 years of age. Therefore, in further analysis, patients were divided into two subgroups: younger recipients (younger than 65 years) and older recipients (aging 65 years or older). Results In the period from 1990 to 2001, patients who were 65 years of age and older were only sporadically treated with kidney transplantation in Croatia. Since 2002, the number of patients older than 65 years undergoing renal transplantation has been increasing. The older recipients * I. Mikolasevic [email protected]
were more likely to receive organs from older donors (52.6 ± 16.8 vs. 45.8 ± 13.2; p = 0.0001). There were no significant differences due to HLA mismatch between the two groups of analyzed patients. There was no difference in the rates of DGF between the older and younger recipients. Older recipients were less likely than younger recipients to have acute rejection crisis during the first-ear after transplantation (16.4 vs. 34.7 %; p = 0.03). There were no significant differences due to readmission rates in the firstyear post-transplantation between the two groups. There was no significant difference due to graft function and 1-year graft and patient’s survival between young and older recipients. Serum creatinine values at 1 year were higher in older recipients who received kidneys from elderly donor. Conclusion Our experience supports the use of kidney transplantation in the population of older ESRD patients. We can increase patients and graft survivals in elderly individuals with careful pre-transplant evaluation and HLA matching. “Croatian senior program” that includes HLA matching represents a good approach for kidney transplantation in older ESRD patients. Keywords Kidney transplantation · Elderly patients · Outcomes
L. Orlic [email protected]
Introduction
1
Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
2
School of Medicine, Rijeka, Croatia
3
Department of Urology, UHC Rijeka, Rijeka, Croatia
4
Department of Anesthesiology and Critical Care, UHC Rijeka, Rijeka, Croatia
Elderly patients are by far the fastest growing population that has a need for renal replacement therapy (RRT) worldwide [1]. Previous studies indicate that about half of the patients receiving RRT in the hemodialysis centers are aged 65 or over. The fast growth in the elderly population of patients primarily results from declines in fertility and mortality rates. Due to the increase in elderly individuals in the
13
1416
population pyramid worldwide, the incidence of chronic diseases (arterial hypertension, diabetes mellitus, coronary artery disease and heart failure) has also risen in the overall population. The rapid growth of the elderly ESRD patients has raised important issues regarding the choice of RRT in these populations of patients. Consequently, during the last decade, the age of patients awaiting kidney transplantation has been increasing. Kidney transplantation is the treatment option of RRT for most of the patients with end-stage renal disease (ESRD) without contraindications for transplantation and with respect to survival, quality of life and costs [2, 3]. Low survival rates and a low quality of life in patients who are treated with hemodialysis make kidney transplantation an attractive treatment option with good clinical results even in elderly recipients. It is generally assumed that older ESRD patients who undergo successful kidney transplantation gain a survival benefit in comparison with those who are treated with hemodialysis [1–5]. Kidney transplantation in elderly patients can be associated with some problems. Due to the widening gap between demand and supply of donor organs, kidney transplantation is rarely offered to older patients with ESRD. Therefore, access to kidney transplantation continues to be limited for older ESRD patients in many countries. Many clinicians consider hemodialysis as a stable strategy with an acceptable survival and few short-term risks. For example, authors from one Canadian study have reported that 26.5 % of patients who are 65 years or older and who have no contraindications to kidney transplantation were not referred for assessment [6]. When an elderly person faces the possibility of kidney transplantation, clinicians often have difficulties in making treatment decisions and must consider many aspects regarding the patient’s underlying condition and probable outcomes. On the basis of the available literature, due to the improving results of kidney transplantation, the impact of the recipient’s age on the short-term and long-term results of transplantation has been considerably reduced. Many authors argue that today age per se is no longer a contraindication to kidney transplantation [7–12]. According to these observations, the aims of this study were to analyze the number of new ESRD patients ≥65 years of age who were managed with kidney transplantation and their survival through the study period. In addition, we have analyzed post-transplantation outcomes in younger and older renal transplant recipients (RTRs).
Patients and methods Using a single-center, retrospective cohort study design (involving data collected prospectively for a purpose not directly related to the current study), we have analyzed 505 renal transplant recipients whose mean age was
13
Int Urol Nephrol (2015) 47:1415–1422
49.7 ± 13.5 years (309 males and 193 females) transplanted at the University Hospital Centre Rijeka between January 1990 and December 2013. Exclusion criteria were: age
