Saturday, November 20, 2010

ASN 2010 Live Update - Transplantation in the Elderly


This was a nice discussion by Dr. Gabriel Danovitch, MD from UCLA during the Medically High-Risk Kidney transplant candidates lecture series.

Take home points:
1.  Decreased relative risk of death after kidney transplant as compared to dialysis leads to increased survival, but Quality of life seems to be worse.
2.  Pre transplant work up is the same Standard w/u for elderly as in the general population.
3.  Overall, lower incident of rejection in elderly (? Weaker immune system)
4.  But Increased donor age seems to be associated with increased risk of Acute rejection and AR treatment in elderly is associated with worse morbidity/mortality than AR treatments in younger patients
5.  Older patients statistically get older patients’ Kidneys and more likely to be listed for ECD kidney.
6.  Dilemma – should living donation be encouraged in Elderly?….. Studies have shown that older patients usually receive suboptimal kidney (read ECD) and have high waiting list time….. But given lower life expectancy is this perhaps a “wasted” younger living kidney??
7.  Elderly patients have higher risk of infectious complication leading to death post transplant.  Also increased risk of lymphoma at this extreme of life
8.  Also have to worry about Polypharmacy in elderly while on immunosuppression.  There are great transplant research drug protocols that are targeted to elderly patients.

Overall, Dr. Danovitch recommends  --  choose patients carefully
Use biological age vs chronological age to help decide?
Make sure patients know what they are getting into – (i.e risk/benefits pertaining to Quality of life issues, other complications, death)
Do not take their immune systems for granted
Older patients do better with younger kidneys
Higher risk of DGF in ECD kidneys
Do not take their immune systems for granted
? Risk of thymo in elderly?  But there is no good data
watch out for infections

By Stanley Crittenden, MD

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