Especially 'elderly' patients should receive a living donor kidney transplant

M. Laging, J.A. Kal-van Gestel, W. Weimar, J.I. Roodnat

Wednesday 13 march 2019

14:24 - 14:26h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: Age criteria for kidney transplantation have been liberalized over the years resulting in more waitlisted elderly patients. However, waiting time may be up to several years, while both age and waiting time are important risk factors for death on the waiting list. In this retrospective cohort study we analyzed how age influenced outflow from the waiting list.

Methods: Between 2000-2013, 2622 patients had been placed on our regional waiting list. Waiting time was defined as the period between start dialysis and being delisted. Patients were categorized according to age at inflow in 64 years (N=564). The influence of ABO blood type and PRA on outflow patterns was studied as well.

Results: At the end of observation (November 2017), 1273 (49%) patients had been transplanted with a living donor kidney, 674 (26%) had been transplanted with a deceased donor kidney, 333 (13%) had been delisted without a transplantation, 271 (10%) had died, and 61 (2%) were still waiting. When comparing the age categories, outflow patterns were completely different. The percentage of patients transplanted decreased with increasing age, while the percentage of patients that had been delisted or had died increased with increasing age, especially in the population without a living donor. After only 2 years, the differences between age categories are clearly visible. While the majority of younger patients had been transplanted, the number of elderly patients that had died or had been delisted increased profoundly in the first years after start dialysis. Although significant, the influence of ABO blood type and PRA on outflow patterns was only modest.

Conclusions: While “elderly” less often receive a living donor kidney transplantation, they cannot bear the waiting time of 3 to 4 years for a deceased donor kidney, resulting in delisting without a transplant in more than half the population of patients over 54 years without a living donor. Age is of paramount importance on outflow from the waiting list. ABO blood type and PRA are less influential when comparing both percentages of patients that had died or had been delisted and percentages of patients that had been transplanted after 6 years. In order to improve their survival, living donor kidney transplantation should be promoted in this “elderly” population.