Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy
Our objectives were to evaluate kidney transplantation survival benefit in people aged ≥70 who were receiving renal replacement therapy (RRT) and to identify their risk factors for posttransplant mortality. This study included all patients in the national French Renal Epidemiology and Information Ne...
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| Veröffentlicht in: | American journal of transplantation 2018-11, Vol.18 (11), p.2695-2707 |
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| container_title | American journal of transplantation |
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| creator | Legeai, Camille Andrianasolo, Roland M. Moranne, Olivier Snanoudj, Renaud Hourmant, Maryvonne Bauwens, Marc Soares, Joaquim Jacquelinet, Christian Couchoud, Cécile Macher, Marie‐Alice |
| description | Our objectives were to evaluate kidney transplantation survival benefit in people aged ≥70 who were receiving renal replacement therapy (RRT) and to identify their risk factors for posttransplant mortality. This study included all patients in the national French Renal Epidemiology and Information Network registry who started RRT between 2002 and 2013 at age ≥70. Mortality risk was compared between patients with transplants; on the waiting list; and on dialysis matched for age, gender, comorbidities, and time on dialysis. Of the 41 716 elderly patients starting RRT, 1219 (2.9%) were on the waiting list and 877 (2.1%) underwent transplantation during the follow‐up. Until month 3, transplant patients had a risk of death triple that of the wait‐listed group. Although the risk was halved at month 9, the perioperative risk was still not offset by month 36. Compared with matched dialysis patients (n = 2183), transplant patients were not at significantly increased perioperative risk and had a lower mortality risk starting at month 3. Risk factors for posttransplant mortality were diabetes, cardiovascular comorbidities, and dialysis duration >2 years. Among older dialysis patients, 20% had neither cardiovascular comorbidity nor diabetes. Systematic early assessment of the eligibility of elderly patients for kidney transplantation is recommended to expand registration to patients with poor survival on dialysis and no cardiovascular comorbidity.
This European study assessing the survival benefit of kidney transplantation for a national cohort of patients beginning renal replacement therapy at the age of 70 years or older shows that elderly patients currently on the waiting list obtain lower survival benefits after kidney transplantation compared to potential benefits to a significant proportion of dialysis patients who are not currently on this list. |
| doi_str_mv | 10.1111/ajt.15110 |
| format | Article |
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This European study assessing the survival benefit of kidney transplantation for a national cohort of patients beginning renal replacement therapy at the age of 70 years or older shows that elderly patients currently on the waiting list obtain lower survival benefits after kidney transplantation compared to potential benefits to a significant proportion of dialysis patients who are not currently on this list.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.15110</identifier><identifier>PMID: 30203618</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Aged ; Cardiovascular diseases ; clinical research/practice ; Cohort Studies ; comorbidities ; Comorbidity ; Diabetes ; Diabetes mellitus ; Dialysis ; Female ; Follow-Up Studies ; Geriatrics ; Graft Rejection - etiology ; Graft Rejection - mortality ; Graft Survival ; Health risk assessment ; health services and outcomes research ; Hemodialysis ; Human health and pathology ; Humans ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - surgery ; Kidney transplantation ; Kidney Transplantation - adverse effects ; Kidney Transplantation - mortality ; kidney transplantation/nephrology ; Kidney transplants ; Life Sciences ; Male ; Mortality ; organ transplantation in general ; patient survival ; Postoperative Complications ; Prognosis ; recipient selection ; registry/registry analysis ; Renal Dialysis - mortality ; Renal replacement therapy ; Renal Replacement Therapy - mortality ; Risk Factors ; Surgery ; Survival ; Survival Rate ; Time Factors ; Transplants & implants ; Urology and Nephrology ; Waiting Lists - mortality</subject><ispartof>American journal of transplantation, 2018-11, Vol.18 (11), p.2695-2707</ispartof><rights>2018 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2018 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4220-f09c61dfded4b532652823756487ef4275bf2813c53af1fc730d7ff306e93d7c3</citedby><cites>FETCH-LOGICAL-c4220-f09c61dfded4b532652823756487ef4275bf2813c53af1fc730d7ff306e93d7c3</cites><orcidid>0000-0002-3127-1415 ; 0000-0002-6657-6235</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.15110$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.15110$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30203618$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.umontpellier.fr/hal-02359418$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Legeai, Camille</creatorcontrib><creatorcontrib>Andrianasolo, Roland M.</creatorcontrib><creatorcontrib>Moranne, Olivier</creatorcontrib><creatorcontrib>Snanoudj, Renaud</creatorcontrib><creatorcontrib>Hourmant, Maryvonne</creatorcontrib><creatorcontrib>Bauwens, Marc</creatorcontrib><creatorcontrib>Soares, Joaquim</creatorcontrib><creatorcontrib>Jacquelinet, Christian</creatorcontrib><creatorcontrib>Couchoud, Cécile</creatorcontrib><creatorcontrib>Macher, Marie‐Alice</creatorcontrib><title>Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>Our objectives were to evaluate kidney transplantation survival benefit in people aged ≥70 who were receiving renal replacement therapy (RRT) and to identify their risk factors for posttransplant mortality. This study included all patients in the national French Renal Epidemiology and Information Network registry who started RRT between 2002 and 2013 at age ≥70. Mortality risk was compared between patients with transplants; on the waiting list; and on dialysis matched for age, gender, comorbidities, and time on dialysis. Of the 41 716 elderly patients starting RRT, 1219 (2.9%) were on the waiting list and 877 (2.1%) underwent transplantation during the follow‐up. Until month 3, transplant patients had a risk of death triple that of the wait‐listed group. Although the risk was halved at month 9, the perioperative risk was still not offset by month 36. Compared with matched dialysis patients (n = 2183), transplant patients were not at significantly increased perioperative risk and had a lower mortality risk starting at month 3. Risk factors for posttransplant mortality were diabetes, cardiovascular comorbidities, and dialysis duration >2 years. Among older dialysis patients, 20% had neither cardiovascular comorbidity nor diabetes. Systematic early assessment of the eligibility of elderly patients for kidney transplantation is recommended to expand registration to patients with poor survival on dialysis and no cardiovascular comorbidity.
This European study assessing the survival benefit of kidney transplantation for a national cohort of patients beginning renal replacement therapy at the age of 70 years or older shows that elderly patients currently on the waiting list obtain lower survival benefits after kidney transplantation compared to potential benefits to a significant proportion of dialysis patients who are not currently on this list.</description><subject>Aged</subject><subject>Cardiovascular diseases</subject><subject>clinical research/practice</subject><subject>Cohort Studies</subject><subject>comorbidities</subject><subject>Comorbidity</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Dialysis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Geriatrics</subject><subject>Graft Rejection - etiology</subject><subject>Graft Rejection - mortality</subject><subject>Graft Survival</subject><subject>Health risk assessment</subject><subject>health services and outcomes research</subject><subject>Hemodialysis</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Kidney Failure, Chronic - surgery</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - mortality</subject><subject>kidney transplantation/nephrology</subject><subject>Kidney transplants</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Mortality</subject><subject>organ transplantation in general</subject><subject>patient survival</subject><subject>Postoperative Complications</subject><subject>Prognosis</subject><subject>recipient selection</subject><subject>registry/registry analysis</subject><subject>Renal Dialysis - mortality</subject><subject>Renal replacement therapy</subject><subject>Renal Replacement Therapy - mortality</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Transplants & implants</subject><subject>Urology and Nephrology</subject><subject>Waiting Lists - mortality</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFuEzEQhi0EoqVw4AWQJS5wSOux1_bmGCqgoEhcytly1uNmw8ZebAe0J14db1OChIQv9oy--WfGPyEvgV1CPVd2Vy5BArBH5BwUYwsFjXh8egt5Rp7lvGMMNG_5U3ImGGdCQXtOfr3DgL4vmUZPv_Uu4ERLsiGPgw3Flj4G6mOilob7wA60i9uYysyPNYWh1to7dFQzOqFNNQqOxsFhornYVPpwRxPOlQmraof7WkPLFpMdp-fkibdDxhcP9wX5-uH97fXNYv3l46fr1XrRNZyzhWfLToHzDl2zkYIrWRcRWqqm1egbruXG8xZEJ4X14DstmNPeC6ZwKZzuxAV5e9Td2sGMqd_bNJloe3OzWps5x7iQywbaH1DZN0d2TPH7AXMx-z53ONQfwXjIhkOFYamZqujrf9BdPKS660zVKbWSoP4271LMOaE_TQDMzA6a6qC5d7Cyrx4UD5s9uhP5x7IKXB2Bn_2A0_-VzOrz7VHyNyd-pD4</recordid><startdate>201811</startdate><enddate>201811</enddate><creator>Legeai, Camille</creator><creator>Andrianasolo, Roland M.</creator><creator>Moranne, Olivier</creator><creator>Snanoudj, Renaud</creator><creator>Hourmant, Maryvonne</creator><creator>Bauwens, Marc</creator><creator>Soares, Joaquim</creator><creator>Jacquelinet, Christian</creator><creator>Couchoud, Cécile</creator><creator>Macher, Marie‐Alice</creator><general>Elsevier Limited</general><general>Elsevier</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-3127-1415</orcidid><orcidid>https://orcid.org/0000-0002-6657-6235</orcidid></search><sort><creationdate>201811</creationdate><title>Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy</title><author>Legeai, Camille ; Andrianasolo, Roland M. ; Moranne, Olivier ; Snanoudj, Renaud ; Hourmant, Maryvonne ; Bauwens, Marc ; Soares, Joaquim ; Jacquelinet, Christian ; Couchoud, Cécile ; Macher, Marie‐Alice</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4220-f09c61dfded4b532652823756487ef4275bf2813c53af1fc730d7ff306e93d7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Cardiovascular diseases</topic><topic>clinical research/practice</topic><topic>Cohort Studies</topic><topic>comorbidities</topic><topic>Comorbidity</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Dialysis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Geriatrics</topic><topic>Graft Rejection - etiology</topic><topic>Graft Rejection - mortality</topic><topic>Graft Survival</topic><topic>Health risk assessment</topic><topic>health services and outcomes research</topic><topic>Hemodialysis</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Kidney Failure, Chronic - surgery</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - mortality</topic><topic>kidney transplantation/nephrology</topic><topic>Kidney transplants</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Mortality</topic><topic>organ transplantation in general</topic><topic>patient survival</topic><topic>Postoperative Complications</topic><topic>Prognosis</topic><topic>recipient selection</topic><topic>registry/registry analysis</topic><topic>Renal Dialysis - mortality</topic><topic>Renal replacement therapy</topic><topic>Renal Replacement Therapy - mortality</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Transplants & implants</topic><topic>Urology and Nephrology</topic><topic>Waiting Lists - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Legeai, Camille</creatorcontrib><creatorcontrib>Andrianasolo, Roland M.</creatorcontrib><creatorcontrib>Moranne, Olivier</creatorcontrib><creatorcontrib>Snanoudj, Renaud</creatorcontrib><creatorcontrib>Hourmant, Maryvonne</creatorcontrib><creatorcontrib>Bauwens, Marc</creatorcontrib><creatorcontrib>Soares, Joaquim</creatorcontrib><creatorcontrib>Jacquelinet, Christian</creatorcontrib><creatorcontrib>Couchoud, Cécile</creatorcontrib><creatorcontrib>Macher, Marie‐Alice</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Legeai, Camille</au><au>Andrianasolo, Roland M.</au><au>Moranne, Olivier</au><au>Snanoudj, Renaud</au><au>Hourmant, Maryvonne</au><au>Bauwens, Marc</au><au>Soares, Joaquim</au><au>Jacquelinet, Christian</au><au>Couchoud, Cécile</au><au>Macher, Marie‐Alice</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2018-11</date><risdate>2018</risdate><volume>18</volume><issue>11</issue><spage>2695</spage><epage>2707</epage><pages>2695-2707</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>Our objectives were to evaluate kidney transplantation survival benefit in people aged ≥70 who were receiving renal replacement therapy (RRT) and to identify their risk factors for posttransplant mortality. This study included all patients in the national French Renal Epidemiology and Information Network registry who started RRT between 2002 and 2013 at age ≥70. Mortality risk was compared between patients with transplants; on the waiting list; and on dialysis matched for age, gender, comorbidities, and time on dialysis. Of the 41 716 elderly patients starting RRT, 1219 (2.9%) were on the waiting list and 877 (2.1%) underwent transplantation during the follow‐up. Until month 3, transplant patients had a risk of death triple that of the wait‐listed group. Although the risk was halved at month 9, the perioperative risk was still not offset by month 36. Compared with matched dialysis patients (n = 2183), transplant patients were not at significantly increased perioperative risk and had a lower mortality risk starting at month 3. Risk factors for posttransplant mortality were diabetes, cardiovascular comorbidities, and dialysis duration >2 years. Among older dialysis patients, 20% had neither cardiovascular comorbidity nor diabetes. Systematic early assessment of the eligibility of elderly patients for kidney transplantation is recommended to expand registration to patients with poor survival on dialysis and no cardiovascular comorbidity.
This European study assessing the survival benefit of kidney transplantation for a national cohort of patients beginning renal replacement therapy at the age of 70 years or older shows that elderly patients currently on the waiting list obtain lower survival benefits after kidney transplantation compared to potential benefits to a significant proportion of dialysis patients who are not currently on this list.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>30203618</pmid><doi>10.1111/ajt.15110</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-3127-1415</orcidid><orcidid>https://orcid.org/0000-0002-6657-6235</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | American journal of transplantation, 2018-11, Vol.18 (11), p.2695-2707 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Cardiovascular diseases clinical research/practice Cohort Studies comorbidities Comorbidity Diabetes Diabetes mellitus Dialysis Female Follow-Up Studies Geriatrics Graft Rejection - etiology Graft Rejection - mortality Graft Survival Health risk assessment health services and outcomes research Hemodialysis Human health and pathology Humans Kidney Failure, Chronic - mortality Kidney Failure, Chronic - surgery Kidney transplantation Kidney Transplantation - adverse effects Kidney Transplantation - mortality kidney transplantation/nephrology Kidney transplants Life Sciences Male Mortality organ transplantation in general patient survival Postoperative Complications Prognosis recipient selection registry/registry analysis Renal Dialysis - mortality Renal replacement therapy Renal Replacement Therapy - mortality Risk Factors Surgery Survival Survival Rate Time Factors Transplants & implants Urology and Nephrology Waiting Lists - mortality |
| title | Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy |
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