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Managing End-Stage Renal Disease in Older Patients: A Single Centre Experience with Renal Transplantation in the Elderly

DOI: 10.1155/2014/516381

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Abstract:

The increase of patients developing end-stage renal disease (ESRD) has occurred predominantly in the older adult population. As a consequence, the nephrologists will need to decide whom of these older patients are siutable for transplantation. There are very few absolute contraindications, such as active infection and recent malignancy, but there are many relative or potential contraindications in older patients. Worldwide, organs available for transplantation are limited. Some centers are reluctant to use organs from expanded criteria donors also in elderly recipients. This leads to long waiting lists and many older patients will die while they are waiting for an organ. It is vital that the patients who are accepted for renal transplantation are those who will derive most benefit, and correct selection of patients and donor organs is therefore of outmost importance. This paper describes the previous and planned research our research group has performed with focus on older renal transplant recipients with special emphasis on survival, basic immunosuppression, selection of organs, and health related quality of life. 1. Introduction The increase of patients developing end-stage renal disease (ESRD) has occurred predominantly in the older adult population. During the last decade the annual incidence rate of ESRD in the USA for those 65 years and older has leveled off but continued to increase for those 75 years and older [1]. In Norway, a small country with just above 5 million inhabitants, a total of 515 new patients entered renal replacement therapy in 2012, that is, 102.6 per million inhabitants. Fifty percent were 65 years or older and a total of 68% were considered by their nephrologists to be a potential candidate for transplantation [2]. As the ESRD population gets older and older the nephrologists will need to decide whom of these older patients are siutable for transplantation. There are very few absolute contraindications, such as active infection and recent malignancy, but there are many relative or potential contraindications especially in older patients. In Norway, there has been no strict upper age limit and in principle transplantation is offered to all patients considered to profit from it. In 2012, 28% of the recipients transplanted were above 65 years. In general, professional groups support renal transplantation for older patients with ESRD. The American Society of Transplantation guidelines on the evaluation of renal transplant candidates state that “there should be no absolute upper age limit for excluding patients whose overall health

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