Bootcongres

Background: It is difficult for elderly patients to find and accept a living kidney donor. How are their chances on the waiting list for a renal transplantation?

Methods: Between January 2000 and July 2011: 2323 patients had been or still were on the regional waiting list for a renal transplantation. Waiting time was defined as time between start dialysis and being removed from the list. Patients were categorised according to age at inflow on the waiting list: group 1:<25 (n=134), group 2: 25-45 (n=583), group 3: 45-55 (n=526), group 4: 55-65 (n=646) and group 5: >65 years (n=434).

Results: In December 2013: 124 (5.3%) patients were still waiting, 532 (23%) patients were delisted without a renal transplantation (278) or died while on the waiting list (254), 1667 (71.8%) received a deceased (DD, 647) or living donor (LD, 1020) renal transplantation. In the period studied 2109 patients were for the first time on the wait list, 188 for the second time, 24 for the third time and 2 for the fourth time. Percentages transplanted (with LD) in groups 1-5 were respectively: 93 (69), 83 (51), 74 (47), 66 (40) and 57 (29) (p<0.001). Percentages removed from the waiting list or dead in groups 1-5 were respectively: 4%, 13%, 20%, 28% and 39% (p<0.001). In the total population, mean waiting time in the 5 age groups was: 2.0±3.1, 2.4±2.7, 2.7±2.9, 2.2±2.3 and 1.9±1.6 years. Waiting time was significantly shorter in group 5 compared to groups 2,3 and 4. After 1.7 years 50% and after 2.7 years 75% of group 5 patients were taken off the list. Mean waiting times in the population removed from the list in the 5 age groups were: 3.8±6.1, 2.8±3.1, 3.8±3.8, 2.3±1.9 and 1.7±1.4 years. Waiting time was significantly shorter in group 5 compared to groups 2,3 and 4. Mean waiting times for DD transplantation in the 5 age categories were: 3.8±2.4, 3.8±2.2, 3.7±2.2, 3.3±2.5, 2.8±1.8 years respectively. Differences were significant between the oldest and all other age categories. Mean waiting times for LD transplantation in the 5 age categories were: 1.0±2.1, 1.4±2.3, 1.7±2.4, 1.5±2.1 and 1.2±1.3 years. Difference was not significant between the groups. 

Conclusion: In the highest age categories 28 and 39% of patients on the waiting list were not transplanted because they did not survive deceased donor waiting time. In this population living donor kidney transplantation lags behind. In order to improve their survival living donor kidney transplantation should be promoted in elderly.