INTRODUCTION AND AIMS: In the last two decades the match for age criteria in the allocation process for Rtx in the E has been increasingly proposed also with the aim to fulfil their expectations. The challenge is to improve the outcome of the E who have been offered kidneys from marginal donors.The aim of the study is to compare survival and immunological/non immunological complications between patients older and younger than 65 years. METHODS: The study consists in a retrospective case-control monocentric analysis of 453 Rtx (11/1987-09/08): 151 >= 65 yrs (range 65-76), 302 between 35-64 yrs. The sampling was random, 1:2, according to the year in which the graft was performed.The demographic characteristics of the two populations, respectively case and control, are: mean age 68.13.1 vs 51.210.6, M/F ratio 101/50 vs 193/108, median of yrs on dialysis 4.3 (0.4-16.6) vs 4.2 (0.3-44.3), single Rtx 95% vs 86%, re-transplants 5% vs 14%; median f-up 2.8 yrs (0-16.1) vs 3.6 yrs (0-17.6). Statistics: Student t Test and Chi-square test when appropriated; actuarial survival curves according to Kaplan Meyer. RESULTS: Graft and patient survival at 1st, 5th, 10th yrs, in case group and in control group, are respectively: 83%, 66% and 48% vs 94%, 82% and 62%, 89%, 75% and 58% vs 98%, 93% and 79%. When considering death-censored actuarial graft curves, no statistical significance was noted: 92%, 84% and 78% vs 95%, 86% and 72%. Statistical differences were noted as for: delayed graft function 45.6% vs 31.5%, urinary tract infections 76% vs 60%, cardiovascular diseases 40% vs 18%, urologic complications 36% vs 26%, cancer 20% vs 8%. No statistical difference was encountered as for acute rejection 24% vs 20%, pneumonia 30% vs 22%, diabetes 21% vs 20%. Main causes of death were: cardiovascular diseases (43% vs 28%, p ns), sepsis (31% vs 27%, p ns) and cancer (23% vs 11%, ns). Despite the E experienced a greater mortality for the three causes, the difference was not statistically significant for any of them. During the f-up, 23% pts of the case group died vs 9% of the other group; the death is the cause of graft loss in 18% of pts over 65 yrs vs 1% recipients of younger group (p<0.05). CONCLUSIONS: The results of our policy in favour of no predetermined age barrier in Rtx are good when looking at graft survival, despite a disturbance not low acute rejection rate (mostly not irreversible rejections) and a greater burden for some complications suffered by the E (>=65 yrs old).Notwithstanding this, an higher mortality in this population is undeniable. The better quality of life by transplantation may be offered also to patients older than 65 yrs of age. The crucial points to maximize the benefits and minimize morbidities and mortality are: careful pre-transplant screening, early diagnosis and treatment of complications and tailored immunosuppressive protocols.
Renal transplantation (Rtx) in 151 elderly patients (E) over 65 years of age: a comparison with a control population younger than 65 years
VIGOTTI, FEDERICA NEVE;LAVACCA, ANTONIO;FOP, FABRIZIO;BIANCONE, Luigi;SEGOLONI, Giuseppe
2009-01-01
Abstract
INTRODUCTION AND AIMS: In the last two decades the match for age criteria in the allocation process for Rtx in the E has been increasingly proposed also with the aim to fulfil their expectations. The challenge is to improve the outcome of the E who have been offered kidneys from marginal donors.The aim of the study is to compare survival and immunological/non immunological complications between patients older and younger than 65 years. METHODS: The study consists in a retrospective case-control monocentric analysis of 453 Rtx (11/1987-09/08): 151 >= 65 yrs (range 65-76), 302 between 35-64 yrs. The sampling was random, 1:2, according to the year in which the graft was performed.The demographic characteristics of the two populations, respectively case and control, are: mean age 68.13.1 vs 51.210.6, M/F ratio 101/50 vs 193/108, median of yrs on dialysis 4.3 (0.4-16.6) vs 4.2 (0.3-44.3), single Rtx 95% vs 86%, re-transplants 5% vs 14%; median f-up 2.8 yrs (0-16.1) vs 3.6 yrs (0-17.6). Statistics: Student t Test and Chi-square test when appropriated; actuarial survival curves according to Kaplan Meyer. RESULTS: Graft and patient survival at 1st, 5th, 10th yrs, in case group and in control group, are respectively: 83%, 66% and 48% vs 94%, 82% and 62%, 89%, 75% and 58% vs 98%, 93% and 79%. When considering death-censored actuarial graft curves, no statistical significance was noted: 92%, 84% and 78% vs 95%, 86% and 72%. Statistical differences were noted as for: delayed graft function 45.6% vs 31.5%, urinary tract infections 76% vs 60%, cardiovascular diseases 40% vs 18%, urologic complications 36% vs 26%, cancer 20% vs 8%. No statistical difference was encountered as for acute rejection 24% vs 20%, pneumonia 30% vs 22%, diabetes 21% vs 20%. Main causes of death were: cardiovascular diseases (43% vs 28%, p ns), sepsis (31% vs 27%, p ns) and cancer (23% vs 11%, ns). Despite the E experienced a greater mortality for the three causes, the difference was not statistically significant for any of them. During the f-up, 23% pts of the case group died vs 9% of the other group; the death is the cause of graft loss in 18% of pts over 65 yrs vs 1% recipients of younger group (p<0.05). CONCLUSIONS: The results of our policy in favour of no predetermined age barrier in Rtx are good when looking at graft survival, despite a disturbance not low acute rejection rate (mostly not irreversible rejections) and a greater burden for some complications suffered by the E (>=65 yrs old).Notwithstanding this, an higher mortality in this population is undeniable. The better quality of life by transplantation may be offered also to patients older than 65 yrs of age. The crucial points to maximize the benefits and minimize morbidities and mortality are: careful pre-transplant screening, early diagnosis and treatment of complications and tailored immunosuppressive protocols.
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