title: Do elderly recipients really benefit from kidney transplantation?
abstract: Data from the nineties showed that even older individuals had a survival advantage with kidney transplantation compared to dialysis. Consequently, we are increasingly wait-listing high-risk patients in terms of age and co-morbidities. However, times are changing. Due to severe organ shortage we now use more often expanded criteria donor kidneys with less favorable outcomes, while at the same time survival on dialysis is improving. The question therefore rises again if elderly patients really benefit from transplantation nowadays. At least for the U.S., recent data still suggest an overall survival benefit with transplantation in older recipients but the risks vary greatly with the health status of the recipient and with the type of donor. Especially for transplant centers outside of the U.S., recent large studies are lacking. Because of continuing changes in both donor and recipient characteristics as well as dialysis outcomes, a permanent area-specific reassessment of data is needed. In this review we describe the important evolutions in transplant and dialysis care over the last 20 years and provide an overview on recent data comparing survival on dialysis versus transplantation in the elderly.
authors.affiliation: Department of Nephrology, Antwerp University Hospital, Edegem, Belgium. Electronic address: rachel.hellemans@uza.be.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hellemans
authors.affiliation: ERA-EDTA registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
authors.affiliation: ERA-EDTA registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: Department of Nephrology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bosmans
authors.affiliation: Department of Nephrology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Abramowicz
mesh_terms: D000368:Aged; D015897:Comorbidity; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D018579:Patient Selection; D015995:Prevalence; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology