Kidney Transplantation in Older Recipients Regarding Surgical and Clinical Complications, Outcomes, and Survival: A Literature Review.

Abstract

Context: The best treatment for end-stage chronic kidney disease (ESKD) is kidney transplantation (KT). As a result of an aging population, each year more kidney transplants in older adults are performed. Nevertheless, older recipients, characterized by more comorbidities and frailty, raise concerns about the outcomes, potential complications, and the general approach. Aim: The aim of this literature review was to study the outcomes, graft and patient survival, as well as common complications, to establish safety and increase awareness of the potential complications of kidney transplantation in the older population. Methods: PubMed and Google scholar databases were searched. The cut-off age defining an old patient was 60 years. The inclusion criteria were as follows: first kidney transplantation, and studies in English language. The exclusion criteria were as follows: more than one organ transplant, dual transplants, articles published before 2015, meta-analysis, reviews, letter to the editor, case reports, and studies published only as a conference abstract. Comparative and noncomparative studies addressing patient survival, death-censored graft survival, surgical complications, and clinical complications, such as delayed graft function (DGF) and biopsy proven acute rejection (PBAR), were included. Results: After screening the papers, 17 studies met the inclusion criteria and were included for review. Eleven papers compared older recipients with younger recipients and in six papers only older patients were analysed. Two studies used paired deceased donors to eliminate donor bias. The rest of the studies used either deceased donors or both living and deceased donors. The majority of patients were male (61.83%) and received a kidney from a deceased donor (58.08%). Conclusions: Kidney transplantation is safe and can be beneficial for recipients over 60 years of age. Older patients suffered more infectious complications, which were also one of the main reasons for death. Most studies did not show a significant difference in death-censored graft survival compared to the younger population. More research is needed to establish the prevalence of surgical complications, and some clinical complications.