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Presenter: Michael, Stephens, cardiff, Afghanistan
Authors: Asderakis A., Stephens M., Ilham M.
EPIDEMIOLOGY AND CLINICAL OUTCOMES
A. Asderakis, M. Stephens, M.A. Ilham
Transplant Unit, University Hospital of Wales, 4XW/UNITED KINGDOM
Body:
Background: In the last few years there has been a disproportionate increase of ESRF in patients over the age of 60. Traditionally there have been restrictions placed in transplantation particularly over the age of 65 since these patients have an increased risk of death with functioning graft. Aim: Study the outcome of patients transplanted over a 7 year period who at the time of transplantation were over 60 or over 65 years old. All the patients over the age of 60 had an echochardiogram at least, and further cardiological investigations if indicated. Diabetics over the age of 55 had always a myoperfusion scan or a coronary angiogram prior to listing. Patients who had a successful revascularisation were also accepted to the list. Results: 113 patients out of 620 were over the age of 60 at the time of transplantation (18.2%) whereas there were 60 patients who were over the age of 65 (9.7%). Diabetes mellitus was less frequent as a cause of failure in patients over the age of 60 (6.2% DM vs. 10.7% in the under 60) suggesting that older diabetics were less likely to be included in the transplant list. Patients over 60 were much more likely to have renovascular disease (17.7 vs 6%). 29% of patient over the age of 60 had at least 1 rejection during the 1st year compared to 34% of the under 60s (NS, this is at an era that most patients did not receive IL-2 receptor blockade). Five years patient survival for patients over the age of 60 was 78.5 vs. 90.6% in the patients under 60 years old (p<0.0001), representing a very good, though different survival. For patients over 65, the 5 year patient survival was very good at 76.5% vs. 89.7% in the ones less than 65 years old (p=0.0001). The censored for death, graft survival was no different between the under and over 60 years old. The 5 year graft survival (including death with a functioning graft) for patients over 60 was 72.9 vs. 80.5% in the patients under 60 years old (p=0.02). Most of this difference was accounted for from the first 18 months post transplant whereas later on the survival curves ran essentially parallel (up to 5 years). Conclusion: Transplantation is becoming increasingly common in the patients over the age of 60 as well as over the age of 65, so that approximately 18 and 10% of transplants are performed respectively for these age groups. Provided these recipients have had a minimum of cardiac evaluation performed, they are safe to transplant and in spite of an inferior patient and graft survival compared to younger patients they still have an excellent outcome that far supersedes their chance of survival on dialysis.
Disclosure: All authors have declared no conflicts of interest.
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