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elderly kidney transplant

Andrea Polistena, Alessandro Sanguinetti, Roberta Lucchini, Segio Galasse, Stefano Avenia, Massimo Monacelli, Louis Banka Johnson, Bengt Jeppsson, Nicola Avenia
BACKGROUND: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. AIM: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. METHODS: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out...
November 9, 2016: Aging Clinical and Experimental Research
Jiang-Tao Tang, Brenda C de Winter, Dennis A Hesselink, Ferdi Sombogaard, Lan-Lan Wang, Teun van Gelder
AIMS: Elderly transplant recipients have a lower incidence of acute rejection, and a higher risk to die from infectious complications. A potential cause may be differences in the pharmacokinetics (PK) or pharmacodynamics (PD) of the immunosuppressive drugs they are taking. This study was designed to comprehensively evaluate the influence of age on the PK and PD of mycophenolic acid (MPA). METHODS: In this study the PK and PD of MPA was studied in 26 elderly and 54 younger renal transplant recipients treated with mycophenolate mofetil and tacrolimus...
October 18, 2016: British Journal of Clinical Pharmacology
Renaud Snanoudj, Marc-Olivier Timsit, Marion Rabant, Claire Tinel, Hélène Lazareth, Lionel Lamhaut, Frank Martinez, Christophe Legendre
Use of expanded criteria donor (ECD) kidneys, which are associated with a reduced graft survival rate, has become widely adopted in elderly recipients in an old-to-old allocation system. However, the results are frequently unsatisfactory, and a high proportion of these ECD kidneys are discarded. Dual kidney transplantation (DKT) is an underutilized way to expand the pool of ECD kidneys and to rapidly transplant elderly patients with satisfactory results because of the transplantation of double the nephronic mass...
September 29, 2016: Transplantation
Kristopher P Croome, David D Lee, Justin M Burns, Dana K Perry, Justin H Nguyen, Andrew P Keaveny, Hani M Wadei, C Burcin Taner
:  Introduction and aim. Many transplant programs have expanded eligibility to include patients previously ineligible because of advanced age. Outcomes of simultaneous liver-kidney transplantation (SLK) in recipients with advanced age are not known. MATERIAL AND METHODS: Data from patients undergoing transplantation between 2002 and 2015 were obtained from the UNOS Standard Analysis and Research file. RESULTS: SLK recipients aged ≥ 65 years (N = 677), SLK recipients aged < 65 years (N = 4517), and recipients of liver transplant alone(LTA) aged ≥ 65 years(N = 8495) were compared...
November 2016: Annals of Hepatology
Hessel Peters-Sengers, Stefan P Berger, Martin B A Heemskerk, Doaa Al Arashi, Jaap J Homan van der Heide, Aline C Hemke, Ineke J M Ten Berge, Mirza M Idu, Michiel G H Betjes, Arjan D van Zuilen, Luuk B Hilbrands, Aiko P J de Vries, Azam S Nurmohamed, Maarten H Christiaans, L W Ernest van Heurn, Johan W de Fijter, Frederike J Bemelman
An increasing number of elderly patients (≥65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (≥18 years) who received a first DBD or DCD kidney during 2002-2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type...
October 11, 2016: Journal of the American Society of Nephrology: JASN
Elias David-Neto, Ana Heloisa Kamada Triboni, Fernanda Ramos, Fabiana Agena, Nelson Zocoler Galante, Marcelo Altona, Francine Brambate Carvalhinho Lemos, Marcelo Tatit Sapienza, William Carlos Nahas
Equations to estimate glomerular filtration rate (eGFR) were developed in patients using the variables age, body weight, and serum creatinine, which may be different in the elderly. Elderly renal transplant patients (EG; n=70; mean age 65 ± 4 y) who measured plasma (51) Cr-EDTA-Clearance (mGFR) had mGFR compared to eGFR obtained by the Cockcroft-Gault corrected by body surface area (CG-BSA), the modification of diet in renal disease (MDRD-4), the Berlin Initiative Study (BIS-1), and the chronic kidney disease epidemiology collaboration (CKD-EPI)...
December 2016: Clinical Transplantation
Kim Ramil C Montaniel, David G Harrison
No abstract text is available yet for this article.
November 1, 2016: Circulation
Sheila Johnston
Chronic kidney disease (CKD) stages 3-5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms...
September 22, 2016: Healthcare (Basel, Switzerland)
Frans J van Ittersum, Aline C Hemke, Friedo W Dekker, Luuk B Hilbrands, Maarten H L Christiaans, Joke I Roodnat, Andries J Hoitsma, Merel van Diepen
Survival of Expanded Criteria Donor (ECD) kidneys and their recipients has not been thoroughly evaluated in Europe. Therefore, we compared outcome of ECD and non-ECD kidney transplantations in a Dutch cohort, stratifying by age and diabetes. In all first Dutch kidney transplants in recipients ≥ 18 years between 1995 and 2005, both relative risks (hazard ratios, HR) and adjusted absolute risk differences (RD) for ECD kidney transplantation were analyzed. In 3062 transplantations (recipient age 49.0 (12.8) years; 20% ECD), ECD kidney transplantation was associated with graft failure including death (HR 1...
September 20, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Miklos Z Molnar, Vanessa Ravel, Elani Streja, Csaba P Kovesdy, Matthew B Rivara, Rajnish Mehrotra, Kamyar Kalantar-Zadeh
OBJECTIVES: To compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx). DESIGN: Prospective cohort. SETTING: Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. PARTICIPANTS: Using data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event...
October 2016: Journal of the American Geriatrics Society
Beatrice P Concepcion, Rachel C Forbes, Aihua Bian, Heidi M Schaefer
Background. The kidney transplant evaluation process for older candidates is complex due to the presence of multiple comorbid conditions. Methods. We retrospectively reviewed patients ≥60 years referred to our center for kidney transplantation over a 3-year period. Variables were collected to identify reasons for patients being turned down and to determine the number of unnecessary tests performed. Statistical analysis was performed to estimate the association between clinical predictors and listing status...
2016: Journal of Transplantation
Barnaby Hole, Sarah Tonkin-Crine, Fergus J Caskey, Paul Roderick
For the majority of patients with end-stage kidney failure (ESKF) replacement of excretory renal function by dialysis or transplantation (RRT) can extend life and alleviate symptoms. Historically, the availability of RRT has been insufficient and this remains the case for much of the world. However, RRT is now widely available in healthcare systems of higher income countries. Increasing numbers of elderly patients are developing ESKF. RRT in this population is largely by dialysis, comorbidity is high and life expectancy short...
November 2016: Seminars in Dialysis
Mitchell H Rosner, Amaka Edeani, Motoko Yanagita, Ilya G Glezerman, Nelson Leung
Paraprotein-related kidney disease represents a complex group of diseases caused by an abnormal paraprotein secreted by a clone of B cells. The disease manifestations range from tubulopathies, such as the Fanconi syndrome, to a spectrum of glomerular diseases that can present with varying degrees of proteinuria and renal dysfunction. Diagnosis of these diseases can be challenging because of the wide range of manifestations as well as the relatively common finding of a serum paraprotein, especially in elderly patients...
August 15, 2016: Clinical Journal of the American Society of Nephrology: CJASN
A Jozwik, P Domagala, R Kieszek, M Wszola, M Serwanska-Swietek, E Karpeta, L Gorski, M Bieniasz, M Jonas, A Berman, L Paczek, M Durlik, A Chmura, A Kwiatkowski
AIM: A major problem for the transplant society is a shortage of organs for transplantation compared with the number of patients on the waiting list. This study aimed to assess the results of the transplantation of kidneys procured from older donors. PATIENTS AND METHODS: A total of 27 kidneys procured from donors age 70 years or older were transplanted between January 1, 2010, and April 25, 2015. These represented only 4.1% of the 657 kidneys transplanted from deceased donors during this period at the same center...
June 2016: Transplantation Proceedings
S Sekta, J Ziaja, A Kolonko, A Lekstan, R Świder, J Klimunt, J Wilk, R Król, M Durlik, A Więcek, L Cierpka
BACKGROUND: Population aging and shortage of organs for transplantation result in increasing numbers of kidneys retrieved from elderly donors. The aim of this study was to analyze donation of kidneys from donors after brain death (DBD) over the age of 60 years (≥60), comorbidities that affect decisions on retrieval, and early results of kidney transplantation. METHODS: Ninety-six potential DBD ≥60 and 309 aged 40-59 years (40-59) reported in Upper Silesia, Poland, from 2004 to 2013 were enrolled in the study...
June 2016: Transplantation Proceedings
D Lewandowska, J Czerwiński, M Hermanowicz, J Przygoda, I Podobińska, R Danielewicz
The age of a donor and recipient is one medical criterion in the kidney allocation system. The number of elderly donors and recipients is steadily growing. The aim of the study was to retrospectively evaluate the 5-year results of kidney transplantation from donors over 65 years of age to recipients over 60 years of age. In the years 1998 to 2010, 8526 potential deceased donation after brain death organ donors and 8206 people (81%), who had been treated with transplantation of kidneys were referred to the Poltransplant...
June 2016: Transplantation Proceedings
Aleksandra Wilk, Elżbieta Kalisińska, Danuta I Kosik-Bogacka, Maciej Romanowski, Jacek Różański, Kazimierz Ciechanowski, Marcin Słojewski, Natalia Łanocha-Arendarczyk
Heavy metals, including cadmium (Cd), lead (Pb) and mercury (Hg) act as nephrotoxic agents, particularly in the renal cortex. The aim of the study was to determine the concentrations of Cd, Pb and Hg in kidneys removed from patients due to lesions of various etiologies and from patients after the rejection of transplanted kidneys. Additionally, we determined the influence of selected biological and environmental factors on the concentrations of toxic metals. The study material consisted of kidneys with tumor lesions (n = 27), without tumors (n = 7) and its extracted grafts (n = 10) obtained from patients belongs to the north-western areas of Poland...
August 2, 2016: Environmental Geochemistry and Health
Liviu Segall, Ionuţ Nistor, Julio Pascual, Istvan Mucsi, Lluis Guirado, Robert Higgins, Steven Van Laecke, Rainer Oberbauer, Wim Van Biesen, Daniel Abramowicz, Cristina Gavrilovici, Ken Farrington, Adrian Covic
During the last 20 years, waiting lists for renal transplantation (RT) have grown significantly older. However, elderly patients (ie ≥65 years of age) are still more rarely referred or accepted to waiting lists and, if enlisted, have less chances of actually receiving a kidney allograft, than younger counterparts. In this review, we looked at evidence for the benefits and risks of RT in the elderly trying to answer the following questions: Should RT be advocated for elderly patients? What should be the criteria to accept elderly patients on the waiting list for RT? What strategies might be used to increase the rate of RT in waitlisted elderly candidates? For selected elderly patients, RT was shown to be superior to dialysis in terms of patient survival...
October 2016: Transplantation
Mary Lynn Davis-Ajami, Jeffery C Fink, Jun Wu
BACKGROUND: Nephrotoxic medication exposure increases risks for acute kidney injury, permanent renal function loss, and costly preventable adverse drug events. Exposure to medications associated with inducing acute tubular nephritis or tubular toxicity versus nonexposure among those with predialysis renal disease-a population vulnerable to increased risk of kidney injury-may affect health services utilization and cost outcomes. Few studies quantify nephrotoxic medication exposure in chronic kidney disease (CKD) and associated costs...
August 2016: Journal of Managed Care & Specialty Pharmacy
Bahar Mirshekar-Syahkal, Dominic Summers, Lisa L Bradbury, Mohamed Aly, Victoria Bardsley, Miriam Berry, Joseph M Norris, Nick Torpey, Menna R Clatworthy, J Andrew Bradley, Gavin J Pettigrew
In the UK, circulatory death (DCD) kidney transplant activity has increased rapidly, but marked regional variation persists. We report how increased DCD kidney transplant activity influenced wait-listed outcomes for a single centre. Between 2002/03 and 2011/12, 430 (54%) DCD and 361 (46%) DBD kidney-only transplants were performed in the Cambridge Transplant Centre, with a higher proportion of DCD donors fulfilling expanded criteria status (41% DCD vs 32% DBD; P=0.01). Compared to UK outcomes, where the proportion of DCD:DBD kidney transplants performed is lower (25%; P<0...
July 18, 2016: American Journal of Transplantation
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