Transplant-eligible patients with kidney failure should not be denied a kidney transplant based on their age, according to investigators in Austria.
They based that conclusion on a study of 4445 patients on a kidney transplant waiting list for their first single-organ deceased-donor kidney. Of these, 3621 (81.5%) received a kidney transplant and 1392 (31.3%) died.
Across all age groups, kidney transplants prolonged survival compared with continuing dialysis and remaining on the waiting list within a 10-year follow-up. The estimated restricted mean survival time (RMST) differences between the groups were 0.57 years for patients aged 20 years, 3.01 years for those aged 60 years, and 2.48 years for those aged 70 years The RMST is the mean survival time of a population within a prespecified time horizon.
“We found a survival benefit for patients who receive a kidney transplant regardless of time spent on the wait list and for all ages of adults who are candidates for kidney transplant,” a team led by Maria C. Haller, MD, MSc, of the Medical University of Vienna in Austria, reported in JAMA Network Open.
Although the long-term follow-up with a reported observation period of 10 years is a study strength, the authors noted, “it is difficult to determine the survival benefit of kidney transplant in younger patients with kidney failure who have a life expectancy longer than 10 years. Therefore, the findings showing only a small survival benefit in younger patients should not be interpreted as ineffectiveness of kidney transplant, but rather a limitation of follow-up in this subgroup.”
The study population included 2974 men (66.9%) and 1471 women (33.1%) aged 18 years or older (mean 52.2 years). Of the 4445 patients, 4237 (95.3%) were on dialysis prior to waiting list placement. Among these patients, the mean time on dialysis before waiting list placement was 478.9 days.
