title: Excess risk of renal allograft loss and early mortality among elderly recipients is associated with poor exercise capacity.
abstract: BACKGROUND
  Successful renal transplantation in the elderly offers substantial benefits in quality and life expectancy. However, in this group of patients there is an early increased risk of death compared with those remaining on dialysis.
  
  
  METHODS
  Graft and patient outcomes in 64 older transplant recipients were compared with 338 patients aged 18 - 59 years. We identified potential risk factors that may predict clinical outcomes in older transplant recipients. A log-rank test and Cox regression analyses were performed to assess the impact of various patient characteristics on graft and patient survival.
  
  
  RESULTS
  Among older patients, graft survival was 76.6% and 67% at 1 and 3 years, respectively. When graft survival was censored for death with functioning graft, the 1- and 3-year graft survival was 83% and 82%, respectively. Patient survival was 78% and 71% at 1 and 3 years, respectively. These survival rates were significantly lower than those of younger recipients. Pretransplant inactivity, delayed graft function, smoking history and longer waiting time predicted poor graft and patient survival. A history of chronic obstructive pulmonary disease, and peripheral vascular disease also predicted a higher mortality among older recipients.
  
  
  CONCLUSIONS
  Older kidney transplant recipients are at high risk for allograft failure and early death. Poor functional capacity predicts a poor outcome for older patients undergoing renal transplantation. Therefore, careful patient selection is paramount, and every effort should be made to initiate timely interventions aimed at increasing physical activity in those with low fitness level.
authors.affiliation: Division of Hypertension and Renal Diseases, Brown University School of Medicine, Rhode Island Hospital, Providence RI, USA. ayango@lifespan.org
authors.forename: A F
authors.initials: AF
authors.lastname: Yango
authors.forename: R Y
authors.initials: RY
authors.lastname: Gohh
authors.forename: A P
authors.initials: AP
authors.lastname: Monaco
authors.forename: S E
authors.initials: SE
authors.lastname: Reinert
authors.forename: A
authors.initials: A
authors.lastname: Gautam
authors.forename: L D
authors.initials: LD
authors.lastname: Dworkin
authors.forename: P E
authors.initials: PE
authors.lastname: Morrissey
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015444:Exercise / Q000502:physiology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D014180:Transplantation / Q000401:mortality; D014184:Transplantation, Homologous / Q000401:mortality* / Q000706:statistics & numerical data*