Is There a Cut Off Age for Kidney Transplant?

Jul 18, 2017 | Mayo Clinic Transplant Staff | @mayoclinictransplantstaff

Nadeen Khoury, M.D. was a special contributor to this blog post. Dr. Khoury is a renal transplant fellow at Mayo Clinic in Rochester, Minnesota. Her interests include kidney transplant in the elderly and pregnancy after kidney transplant.

One hot topic in the world of transplant has been what the appropriate cut off age should be for patients in need of a transplant. Across the globe, age criteria have been loosely defined. The American Society of Transplantation’s guidelines state “There should be no absolute upper age limit for excluding patients whose overall health and life situation suggest that transplantation will be beneficial.” This topic continues to be examined as the number of elderly individuals in our society has exponentially increased. 2017-6-22 Tx in elderly

Trends in the national kidney waiting list demonstrate the dynamic of an aging population and their need for transplant due to End Stage Renal Disease (ESRD).

In 2005, 14.5% of listed patients were over age 65
In 2015, 22% of listed patients were over age 65

The prevalence of ESRD patients on dialysis is increasing among older age groups, as well. In fact, 44.5% of patients with ESRD receiving maintenance dialysis are 65 and older.

Based on this, it’s not surprising to learn there was a 325% increase in deceased donor transplants performed on patients 65 and older between 1997 and 2014, and a 380% increase in living donor transplants during the same period, according to the United States Renal Data Systems Annual Data Report.

If you are age 65 or older and in need of a kidney transplant, or a caregiver of someone who is, here are three key factors to keep in mind as you begin on your journey to transplantation.

Thorough evaluation is imperative for determining whether or not you are well-suited for transplant. One key aspect of transplant evaluation in patients age 65 and older is analysis of frailty. Frailty is typically measured by using assessment tools that look at the ability to complete activities of daily living, risk of developing bed sores, and likelihood of falling. Often patients who have frailty pre-transplant are more likely to experience surgical complications, delayed graft function, a longer hospital stay as well as discharge to a skilled nursing facility for further recovery. Do what you can to maintain a level of strength pre-transplant in order to reduce your risk of these complications.
The best results for kidney transplant in patients 65 and older are when the kidney is from a living donor. These kidneys are more likely to function immediately and provide better outcomes. When living organ donation is not an option, your transplant provider will look at deceased kidney transplant as an alternative.
Interestingly, older recipient age is associated with lower risk of rejection because the immune system weakens with age. Each transplant center has its own protocol for immunosuppression in the elderly. At Mayo Clinic, immunosuppressant medications are tailored to minimize the risk of infection.

If you're currently awaiting a transplant, has age been a factor in your care plan? If so, how?

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