Kidney transplantation in elderly people: The influence of recipient comorbidity and living kidney donors

OBJECTIVES: To examine the extent to which donor and recipient characteristics were associated with transplant outcomes in elderly kidney transplant recipients. DESIGN: Retrospective review. SETTING: Single university center. PARTICIPANTS: One thousand one hundred two patients, including 266 patients aged 60 and older. MEASUREMENTS: Recipient and donor characteristics and patient and graft outcomes. RESULTS: Of the 1,102 patients included in this study, 266 (25%) were aged 60 and older, and 117 (11%) were aged 67 and older. According to Cox proportional hazards analysis, patient survival was worse in elderly recipients, although the survival outcome in the oldest group (ages 68-86) was comparable with that in their slightly younger peers (ages 61-67). Graft function did not differ according to age. Comorbidity was a significant predictor of patient survival in elderly recipients (hazard ratio (HR)=1.17, 95% confidence interval (CI)=1.03-1.34, P=.02) but not in the subset of elderly recipients of living donor kidneys (HR=1.01, 95% CI=0.8-1.3, P=.9). CONCLUSION: Older adults can achieve good outcomes with kidney transplantation, although in recipients with significant comorbid illness, careful donor selection and selective use of living donors may be vital to achieving good outcomes.