title: Kidney Transplantation Among the Elderly: Challenges and Opportunities to Improve Outcomes.
abstract: Elderly patients (>65 years old) represent the fastest growing population among the ESRD patients and those awaiting kidney transplantation. There is ample evidence to suggest that kidney transplant in the elderly population offers the best chance of survival and improves health-related quality of life compared to remaining on dialysis. Although all these emerging facts are encouraging, this population brings with them complex medical problems including frailty, cognitive impairment, and multiple comorbidities. These issues can be barriers to transplantation and threaten the well-being of the patients after transplantation. Furthermore, aging results in changes to the immune system and affects the pharmacokinetics of immunosuppressants. All these changes can increase risk of complications such as infections and malignancy. Because death with a functioning graft is a common cause of graft loss, the new kidney allocation system has been implemented in an attempt to maximize allograft utilization and minimize unrealized graft years. This may result in longer wait-times for the elderly. In this review, we will highlight the barriers to kidney transplant, characterize transplant-related issues in the elderly, and propose alternative strategies under the new allocation system.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of New Mexico.
authors.forename: Pooja
authors.initials: P
authors.lastname: Singh
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of New Mexico.
authors.forename: Yue-Harn
authors.initials: YH
authors.lastname: Ng
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of New Mexico. Electronic address: mlunruh@salud.unm.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006297:Health Services Accessibility; D006299:Health Services for the Aged; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation; D011788:Quality of Life; D006435:Renal Dialysis; D016896:Treatment Outcome
keywords: Aging; Frail elderly; Immunosuppression; Kidney transplantation; Survival