Renal transplantation and the older adult patient
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Washington University School of Medicine
- Emilio Ramos, MD, FACP
Emilio Ramos, MD, FACP
- Clinical Professor of Medicine
- University of Buffalo, School of Medicine
- Buffalo, NY
Renal transplantation improves the long-term survival and quality of life of most patients with end-stage renal disease (ESRD), including older patients. However, individual older patients who have significant comorbidities may not live long enough to realize the benefits of transplantation, which are not observed until a number of months to years after transplantation. It is important to carefully evaluate older patients who are being considered for renal transplantation in order to avoid subjecting the patient to an invasive procedure from which he or she will not benefit and to avoid wasting a kidney that could provide years of benefit to another recipient.
This topic reviews issues surrounding renal transplantation among older adults.
The evaluation of potential kidney transplant donors and recipients, the kidney transplant waiting list, and the allocation of deceased-donor kidneys are discussed elsewhere. (See "Evaluation of the potential renal transplant recipient" and "Evaluation of the living kidney donor" and "The kidney transplant waiting list in the United States" and "Organ sharing in kidney transplantation".)
The age of renal transplant patients has increased over the past 20 to 25 years. Sixty percent of patients who enter end-stage renal disease (ESRD) are ≥60 years of age . The number of transplants performed annually among patients ≥65 years has tripled between 1998 and 2011 [1,2]. The percentage of candidates >50 years on the transplant waiting list increased from 53 to 64 percent between 2003 and 2013, with a corresponding decrease in younger patients .
A comprehensive evaluation of the prospective older transplant recipient includes the identification of significant comorbid disease that may preclude transplantation. Because the benefits of renal transplantation on patient survival are generally not realized until 1.5 to 2 years after transplantation, patients who are unlikely to survive this long should not undergo transplantation.
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