Does kidney transplant have advantages over dialysis in the elderly?
Comparison of patients ≥70 years who remained on wait list for kidney transplantation to those patients transplanted indicated transplanted patients had 41% decreased risk of death.
Mortality benefit was also seen in those elderly with diabetes and those that received extended criteria donors. These findings confirm similar comparisons in those aged 60 to 74 years with noted 61% lower mortality for transplanted elderly compared to wait-listed elderly with a calculated 4-year increase in life expectancy.
Prediction models on nearly 129,000 adults ≥65 years with Medicare-primary incident ESKD from United States Renal Data System and nearly 7000 Medicare-primary first-kidney transplant recipients of the United Network Organ Sharing evaluating post-transplant outcomes suggest that 9.1% of the patients are excellent candidates with 3-year post-kidney transplant survival of 87.6% or higher. While living donation is ideal, older donors may face difficulty in receiving a standard-criteria donor transplant, given current allocation based on Kidney Donor Profile Index. Patients ≥60 years who receive older donor kidneys and extended-criteria donor continue to have lifetime benefits of allograft function and should be encouraged. While frailty as a state of decreased physiologic reserve with unintentional weight loss, loss of grip strength weakness, slow walking speed, low physical activity, and self-noted exhaustion affects mortality in the elderly, lower frailty scores are beneficial for survival in elderly whether initiating dialysis or after transplantation. These data suggest continued advantage of kidney transplant over dialysis maintenance in the elderly, and older individuals should be considered for kidney transplant referral if medically eligible.
