Survival of Patients Older Than 60 Years With Kidneys Transplanted From Spanish Expanded Criteria Donors Versus Patients Continued on Hemodialysis

• Published in: Transplantation proceedings Vol. 41; no. 6; pp. 2376 - 2378
• Main Authors: Martín Navarro, J, Ortega, M, Gutiérrez, M.J, García Martín, F, Alcázar, J.M, Morales, J.M, Andrés, A, Praga, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01-07-2009; Elsevier
• Subjects: Actuarial Analysis; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cadaver; Comorbidity; Emergency and intensive care: renal failure. Dialysis management; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival - physiology; Humans; Intensive care medicine; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; Kidney Failure, Chronic - therapy; Kidney Transplantation - mortality; Kidney Transplantation - physiology; Male; Medical sciences; Middle Aged; Patient Selection; Renal Dialysis; Retrospective Studies; Spain; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Tissue Donors; Tissue, organ and graft immunology; Waiting Lists; Europe; Spain; Suboptimal donor; Human; Prognosis; Hemodialysis; Patient; Transplantation; Homotransplantation; Survival; Kidney; Medicine; Extrarenal dialysis; Treatment; Urinary system; Surgery; Graft; Spanish; Elderly; Age; Comparative study
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.06.176

Abstract A retrospective study was performed in patients >60 years of age who had initiated hemodialysis (HD) at our hospital between 2000 and 2005 (n = 211). Of these, 47 were placed on the kidney transplantation waiting list and 164 were excluded and continued on HD. Cadaveric transplantation was performed in 31 patients using an expanded criteria donor organ (TR), while 16 remained on the waiting list (WL). We compared the 12-month survivals of patients in the 3 groups (TR/WL/HD), namely, 97%/78%/75% ( P < .045). Survival at 24, 36, 48, and 60 months for TR/HD were 89%/57%; 86%/43%; 79%/32%; and 70%/16% ( P < .001). HD patients showed greater comorbidity than TR patients: Charlson index >8 was 67.9% vs 19.4%. A total of 23.7% of patients were excluded solely due to advanced age. We compared survivals among the TR patients vs those excluded only because of age using paired comorbidity (Charlson index <8): 97%/95%, 89%/58%, and 86%/44% at 12, 24, and 36 months ( P < .023). We concluded that kidney transplantation with an expanded criteria donor organ in elderly patients was a procedure that provided greater survival than HD for patients excluded from transplantation, for patients on the WL who did not receive a transplant, and for patients excluded solely due to advanced age who showed comorbidity comparable to the transplant recipients. According to our data, elderly patients with low comorbidity should be considered for inclusion on the WL for transplantation.