End-stage renal disease patients older than 70 years experience who receive a renal transplant experience a significant improvement in survival compared with remaining on dialysis, data suggest.
Investigators led by Kristian Heldal, MD, of the Clinic of Internal Medicine, Sykehuset Telemark, Norway, examined data on 286 patients older than 70 years who started dialysis between 1990 and 2005 and who were placed on kidney transplantation waitlist.
At the start of dialysis, patients had a median age of 73.1 years. Of the 286 patients, 233 (81%) received a transplant during follow-up. At the time of transplantation, the patients had a median age of 74.3 years. Patients were followed up until death or until May 1, 2008.
Median survival of the 53 patients remaining on dialysis was 3.4 years compared with 4.8 years for the transplant recipients, according to a report in Nephrology Dialysis Transplantation (2009; published online ahead of print).Five-year survival was 31% for those on the waitlist versus 49% for the transplant recipients.Patients starting dialysis between 1990 and 1999 had no significant long-term survival benefit from transplantation, whereas those starting dialysis after 2000 experienced a 60% decreased risk of death after receiving a transplant.In both groups, however, transplantation was associated with decreased survival within the first year compared with continued dialysis. Within the first year of transplantation, median survival was 79% and 89% for those who started dialysis between 1990 and 1999 and between 2000 and 2005, respectively. In contrast, within the first year of starting dialysis, survival rates were 93% and 98%, respectively.“Survival after kidney transplantation in patients over 70 years has improved during the last decade and offers a survival advantage over dialysis treatment,” the researchers concluded. “Our experience supports the use of kidney transplantation in this age group if an increased early post-operative risk is accepted.”