Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis

Alberto Artiles; Ana Domínguez; José Daniel Subiela; Romain Boissier; Riccardo Campi; Thommas Prudhomme; Alessio Pecoraro; Alberto Breda; Francisco Javier Burgos; Angelo Territo; Vital Hevia; EAU-YAU Kidney Transplantation Working Group

doi:10.1016/j.euros.2023.02.011

Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis

Eur Urol Open Sci. 2023 Mar 22:51:13-25. doi: 10.1016/j.euros.2023.02.011. eCollection 2023 May.

Affiliations

¹ Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain.
² Aix-Marseille University, Marseille, France.
³ Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique, Marseille, France.
⁴ Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
⁵ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁶ Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France.
⁷ Urology Department, Fundación Puigvert, University Autónoma of Barcelona, Barcelona, Spain.

Abstract

Context: Owing to population ageing, a growing number of kidney transplants (KTs) in elderly population are being performed. KT is the best treatment for patients with end-stage renal disease (ESRD). However, in older patients, the decision between dialysis and KT can be difficult due to potential inferior outcomes. Few studies have been published addressing this issue, and literature outcomes are controversial.

Objective: To conduct a systematic review and meta-analysis to appraise the evidence about outcomes of KT in elderly patients (>70 yr).

Evidence acquisition: A systematic review and meta-analysis (PROSPERO registration: CRD42022337038) was performed. Search was conducted on PubMed and LILACS databases. Comparative and noncomparative studies addressing outcomes (overall survival [OS], graft survival [GS], complications, delayed graft function [DGF], primary nonfunction, graft loss, estimated glomerular filtrate rate, or acute rejection) of KT in people older than 70 yr were included.

Evidence synthesis: Of the 10 357 yielded articles, 19 met the inclusion criteria (18 observational studies, one prospective multicentre study, and no randomised controlled trials), enrolling a total of 293 501 KT patients. Comparative studies reporting enough quantitative data for target outcomes were combined. There were significant inferior 5-yr OS (relative risk [RR], 1.66; 95% confidence interval [CI], 1.18-2.35) and 5-yr GS in the elderly group (RR, 1.37; 95% CI, 1.14-1.65) to those in the <70-yr group. Short-term GS at 1 and 3 yr was similar between groups, and similar findings occurred with DGF, graft loss, and acute rejection rates. Few data about postoperative complications were reported.

Conclusions: Elderly recipients have worse OS at all time points and long-term GS compared with younger recipients (<70 yr). Postoperative complications were under-reported and could not be assessed. The DGF, acute rejection, death with functioning graft, and graft loss were not inferior in elderly recipients. Geriatric assessment in this setting might be useful for selecting better elderly candidates for KT.

Patient summary: Compared with younger population, kidney transplant in elderly patients has inferior patient and graft survival outcomes in the long term.

Keywords: Elderly population; Geriatric; Kidney transplant; Meta-analysis; Renal transplantation; Systematic review.

Publication types

Review