title: Patient and graft survival in older kidney transplant recipients: does age matter?
abstract: An increasing gap between supply and demand of donor kidneys for transplantation exists. There is concern regarding the allocation of scarce organs to elderly patients, because the benefit obtained by the transplant may be less in elderly compared with younger recipients. It was the objective of this study to determine differences in patient and organ survival between organ recipients >65 yr and 50 to 64 yr of age at transplantation. A retrospective cohort of 627 patients >50 yr who received a kidney transplant between 1993 and 2000 was assembled. Detailed information on patient demographics, comorbidities, and immunological and donor characteristics was ascertained before transplantation. Five-year patient and graft survival were evaluated by Kaplan-Meier survival curves and multivariate Cox proportional-hazard models. Five-year patient mortality was similar between patients aged >65 and 60 to 64 at transplantation (relative risk [RR] = 1.07; 95% confidence interval [CI], 0.66 to 1.74). Patients aged 50 to 59 yr showed a clear trend toward lower 5-yr mortality (RR = 0.66; 95% CI, 0.43 to 1.03). Compared with patients >65 yr, 5-yr graft loss was not different in patients aged 60 to 64 (RR = 1.28; 95% CI, 0.82 to 2.02) or those aged 50 to 59 yr at transplantation (RR = 1.02; 95% CI, 0.68 to 1.53). After thorough control for confounding, 5-yr graft survival was not materially different by age group. Discrimination against older candidates for kidney transplantation on age-related grounds alone is not warranted.
authors.affiliation: Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. veronika.fabrizii@akh-wien.ac.at
authors.forename: Veronika
authors.initials: V
authors.lastname: Fabrizii
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.forename: Renate
authors.initials: R
authors.lastname: Klauser
authors.forename: Josef
authors.initials: J
authors.lastname: Kletzmayr
authors.forename: Markus D
authors.initials: MD
authors.lastname: Säemann
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steininger
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Josef
authors.initials: J
authors.lastname: Kovarik
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors