Access to kidney transplantation increases for elderly patients

Oct 29 2010

Elderly patients with kidney failure get kidney transplants more often than they did a decade ago, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The results suggest that the chances of receiving a kidney transplant are better than ever for an older patient who needs one.

Kidney failure afflicts nearly half a million individuals in the United States, and 48% of sufferers are 60 years of age or older. Kidney disease patients who obtain a transplant live longer than those that remain on dialysis. Fortunately, living and deceased organ donations are on the rise; however, transplant waiting lists have become increasingly long as more and more people develop kidney dysfunction.

Elke Schaeffner, MD (Charité University Medicine, in Berlin, Germany), along with Caren Rose and John Gill, MD (St. Paul's Hospital, University of British Columbia, in Vancouver, Canada) examined whether elderly patients with kidney failure have better or worse access to transplants now than they did in the past. The study included patients with kidney failure in the United States aged 60 to 75 years listed in the United States Renal Data System between 1995 and 2006.

The study revealed that elderly patients rarely receive a transplant, but they were twice as likely to get one in 2006 as in 1995. (In 2006, they had a 7.3% likelihood of getting a transplant within three years of their first treatment for kidney failure.) Elderly patients now benefit from greater access to organs from living donors and older deceased donors compared to a decade ago. They also die less frequently while waiting for a kidney than they did in the past.

The authors urge clinicians to encourage elderly patients with kidney disease to consider transplantation over other forms of treatment. "Early engagement and education of patients and their families about the benefits and opportunities for transplantation may lead to further increases in the use of… transplantation in this age group. Policy changes and research are also needed to further expand access to transplantation in the elderly," they wrote.

In reviewing the results of this study in an accompanying editorial, Suphamai Bunnapradist, MD and Gabriel Danovitch, MD (David Geffen School of Medicine at the University of California, Los Angeles) noted that elderly patients' probability of receiving a transplant in the latter part of the study period remained quite small and that barriers to transplantation are more pronounced in elderly candidates. "Practitioners should consider in a careful and compassionate manner whether transplantation is a realistic option for each elderly end-stage renal disease candidate," they wrote. "Each transplant program must carefully consider the most cost-effective and clinically rational manner in which their elderly candidates are evaluated and managed while on the waiting list."