Are octogenarians with end stage renal disease candidates for renal transplantation?.

Background: Elderly patients are the fastest growing group in need of renal transplantation. This study puts focus on renal transplant recipients in their eightieth year or older at time of engraftment. Is there evidence to support an absolute upper age limit for renal transplantation? Methods: Recipients in their eightieth year or older, transplanted between 1983 and 2015, were included. Data were retrieved from the Norwegian Renal Registry in the end of October 2015. Graft and patient survival were compared to recipients aged 70-79 years at transplantation. Results: 47 patients older than 79 years were transplanted in the defined period. Median age 80.1 years, 81 % were male. Median time on dialysis prior to transplantation was 18.5 months. All patients received an allograft from a deceased donor (median donor age 61.8 years). In the death censored graft survival model, there was no statistical difference between the groups. We found improved patient and graft survival after introduction of mycophenolate mofetil and induction with basiliximab. Patients transplanted before 2000 had increased risk of death compared to those transplanted after 2000; HR 3.2 (95% CI 1.2-8.7). Median uncensored graft survival for patients transplanted after the year 2000 was 5.0 year (95% CI 2.4-7.6). Median patient survival was 5.0 years (3.1-6.9) and five year patient survival was 55 %. Conclusion: Age by itself should not be an absolute contraindication against renal transplantation. An estimated five years survival rate of 55 % post-engraftment for an 80 years old patient is in our opinion more than acceptable. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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