Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant.
OBJECTIVE
Waiting times to deceased-donor transplantation (DDTx) have significantly increased in the past decade. This trend particularly affects older candidates given a high mortality rate on dialysis.


METHODS
We conducted a retrospective analysis from the national Scientific Registry of Transplant Recipients database that included 54,669 candidates who were older than 60 yr and listed in the United States for a solitary kidney transplant from 1995 through 2007. Using survival models, we estimated time to DDTx and mortality after candidate listing with and without patients initially listed as temporarily inactive (status 7).


RESULTS
Almost half (46%) of candidates who were older than 60 yr and listed in 2006 through 2007 are projected to die before receiving a DDTx. This proportion varied by individual characteristics: Diabetes (61%), age > or =70 yr (52%), black (62%), blood types O (60%) and B (71%), highly sensitized (68%), and on dialysis at listing (53%). Marked variation also existed by United Network for Organ Sharing region (6 to 81%). The overall projected proportion was reduced to 35% excluding patients who initially were listed as status 7.


CONCLUSIONS
These data highlight the prominent and growing challenge facing the field of kidney transplantation. Older candidates are now at significant risk for not surviving the interval in which a deceased-donor transplant would become available. Importantly, this risk is variable within this population, and specific information should be disseminated to patients and caregivers to facilitate informed decision-making and potential incentives to seek living donors.
Schold
Jesse
J
Department of Medicine, University of Florida, Gainesville, FL 32610-0224, USA. scholjd@medicine.ufl.edu
Srinivas
Titte R
TR
Sehgal
Ashwini R
AR
Meier-Kriesche
Herwig-Ulf
HU
D000017:ABO Blood-Group System; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D002102:Cadaver; D048909:Diabetes Complications / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014850:Waiting Lists
D000017:ABO Blood-Group System