title: Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease: A Literature Review and Position Statement on Behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice.
abstract: During the last 20 years, waiting lists for renal transplantation (RT) have grown significantly older. However, elderly patients (ie ≥65 years of age) are still more rarely referred or accepted to waiting lists and, if enlisted, have less chances of actually receiving a kidney allograft, than younger counterparts. In this review, we looked at evidence for the benefits and risks of RT in the elderly trying to answer the following questions: Should RT be advocated for elderly patients? What should be the criteria to accept elderly patients on the waiting list for RT? What strategies might be used to increase the rate of RT in waitlisted elderly candidates? For selected elderly patients, RT was shown to be superior to dialysis in terms of patient survival. Virtually all guidelines recommend that patients should not be deemed ineligible for RT based on age alone, although a short life expectancy generally might preclude RT. Concerning the assessment of comorbidities in the elderly, special attention should be paid to cardiac evaluation and screening for malignancy. Comorbidity scores and frailty assessment scales might help the decision making on eligibility. Psychosocial issues should also be evaluated. To overcome the scarcity of organ donors, elderly RT candidates should be encouraged to consider expanded criteria donors and living donors, as alternatives to deceased standard criteria donors. It has been demonstrated that expanded criteria donor RT in patients 60 years or older is associated with higher survival rates than remaining on dialysis, whereas living donor RT is superior to all other options.
authors.affiliation: 1 Nefrocare MS Dialysis Centre, Iaşi, Romania. 2 Nephrology Department, Dr. C. I. Parhon Hospital, University of Medicine and Pharmacy Gr. T. Popa, Iaşi, Romania. 3 European Renal Best Practice (ERBP), Ghent University Hospital, Ghent, Belgium. 4 Department of Nephrology, Hospital del Mar, Barcelona, Spain. 5 Institut Mar for Medical Research, Barcelona, Spain. 6 Descartes Working Group of ERA-EDTA, London, UK. 7 Division of Nephrology and Multiorgan Transplant Program, University Health Network and University of Toronto, Toronto, Canada. 8 Unidad de Trasplante Renal, Servicio de Nefrologia, Fundació Puigvert, Barcelona, Spain. 9 University Hospital Coventry and Warwickshire and University of Warwick, Coventry, United Kingdom. 10 Renal Division, Ghent University Hospital, Ghent, Belgium. 11 Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria. 12 Nephrology Department, Antwerp University Hospital, Antwerp, Belgium. 13 Center for Health Policy and Ethics, "Gr.T. Popa" University of Medicine and Pharmacy, Iasi, Romania. 14 Renal Unit, Lister Hospital, Stevenage UK and Centre for Clinical and Health Services Research, University of Herts, United Kingdom.
authors.forename: Liviu
authors.initials: L
authors.lastname: Segall
authors.forename: Ionuţ
authors.initials: I
authors.lastname: Nistor
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.forename: Lluis
authors.initials: L
authors.lastname: Guirado
authors.forename: Robert
authors.initials: R
authors.lastname: Higgins
authors.forename: Steven
authors.initials: S
authors.lastname: Van Laecke
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.forename: Daniel
authors.initials: D
authors.lastname: Abramowicz
authors.forename: Cristina
authors.initials: C
authors.lastname: Gavrilovici
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016330:Frail Elderly; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D006435:Renal Dialysis; D040242:Risk Reduction Behavior