TY - JOUR
T1 - Transplantation in older individuals: is it really better than dialysis?
AU - Hellemans, Rachel
AU - Jager, Kitty J.
AU - Abramowicz, Daniel
PY - 2020/2/1
Y1 - 2020/2/1
N2 - PURPOSE OF REVIEW: The kidney transplantation landscape has changed dramatically over the last 2 decades. First, transplantation is performed in patients previously considered ineligible for transplantation, including older patients and patients with multiple comorbidities. Second, organ shortages have increased the use of less-than-optimal donor kidneys, like organs from expanded criteria donors or donors after cardiac death. Third, improvements in managing chronic kidney disease and dialysis have improved survival on dialysis. Therefore, the question arises: does transplantation currently benefit older transplant candidates? RECENT FINDINGS: The current review describes important changes in transplantation over the last 20 years. We review recent data on survival with dialysis versus transplantation in older individuals. Finally, we consider methodological issues that might influence conclusions drawn in current studies. SUMMARY: Limited data are available to assess the potential survival benefit of kidney transplantations in older individuals. The available evidence suggests that transplantation might provide survival benefit in older individuals, even with aged kidney donors, but risks vary widely with donor quality and recipient health status. More research is needed to make adequate predictions of which donor kidneys might lead to good outcomes and which patient characteristics might define a good transplant candidate.
AB - PURPOSE OF REVIEW: The kidney transplantation landscape has changed dramatically over the last 2 decades. First, transplantation is performed in patients previously considered ineligible for transplantation, including older patients and patients with multiple comorbidities. Second, organ shortages have increased the use of less-than-optimal donor kidneys, like organs from expanded criteria donors or donors after cardiac death. Third, improvements in managing chronic kidney disease and dialysis have improved survival on dialysis. Therefore, the question arises: does transplantation currently benefit older transplant candidates? RECENT FINDINGS: The current review describes important changes in transplantation over the last 20 years. We review recent data on survival with dialysis versus transplantation in older individuals. Finally, we consider methodological issues that might influence conclusions drawn in current studies. SUMMARY: Limited data are available to assess the potential survival benefit of kidney transplantations in older individuals. The available evidence suggests that transplantation might provide survival benefit in older individuals, even with aged kidney donors, but risks vary widely with donor quality and recipient health status. More research is needed to make adequate predictions of which donor kidneys might lead to good outcomes and which patient characteristics might define a good transplant candidate.
KW - dialysis
KW - expanded criteria donor
KW - kidney transplantation
KW - older recipients
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85077224251&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/MOT.0000000000000723
DO - https://doi.org/10.1097/MOT.0000000000000723
M3 - Review article
C2 - 31833965
SN - 1087-2418
VL - 25
SP - 86
EP - 91
JO - Current opinion in organ transplantation
JF - Current opinion in organ transplantation
IS - 1
ER -