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Trends in Kidney Transplant Outcomes in Older Adults
Objectives To estimate mortality and death‐censored graft loss according to year of kidney transplant (KT) between 1990 and 2011. Design Cohort study. Setting The Scientific Registry of Transplant Recipients (SRTR). Participants KT recipients aged 65 and older at the time of transplantation (N = 30,...
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| Published in: | Journal of the American Geriatrics Society (JAGS) 2014-12, Vol.62 (12), p.2235-2242 |
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| cites | cdi_FETCH-LOGICAL-c4560-f2ad58ccc16965d6dea101f8a6a012c3642f03f4d60df7fb27a1181acde51ed63 |
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| container_issue | 12 |
| container_start_page | 2235 |
| container_title | Journal of the American Geriatrics Society (JAGS) |
| container_volume | 62 |
| creator | McAdams-DeMarco, Mara A. James, Nathan Salter, Megan L. Walston, Jeremy Segev, Dorry L. |
| description | Objectives
To estimate mortality and death‐censored graft loss according to year of kidney transplant (KT) between 1990 and 2011.
Design
Cohort study.
Setting
The Scientific Registry of Transplant Recipients (SRTR).
Participants
KT recipients aged 65 and older at the time of transplantation (N = 30,207).
Measurements
Mortality and death‐censored graft loss ascertained through center report and linkage to Social Security Death Master File and to Medicare.
Results
Older adults currently account for 18.4% of KT recipients, up from 3.4% in 1990; similar increases were noted for deceased donor (5.4 times percentage increase) and live donor (9.1 times percentage increase) transplants. Current recipients are not only older, but also more likely to be female and African American, have lengthier pretransplant dialysis, have diabetes mellitus or hypertension, and receive marginal kidneys. Mortality for older deceased donor recipients between 2009 and 2011 was 57% lower (hazard ratio (HR) = 0.43, 95% confidence interval (CI) = 0.33–0.56, P |
| doi_str_mv | 10.1111/jgs.13130 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1638001014</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3528496261</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4560-f2ad58ccc16965d6dea101f8a6a012c3642f03f4d60df7fb27a1181acde51ed63</originalsourceid><addsrcrecordid>eNp10ElLxDAYBuAgio7LwT8gBRH0UM2Xre1xFB03nIMjipcQs0jHTjsmLTr_3uiMCoK55JDnW_IitA34EOI5Gj-HQ6BA8RLqAack5Qz4MuphjEmaC2BraD2EMcZAcJ6vojXCGS0o4T3ERt7WJiRlnVyVprazZORVHaaVqttk2LW6mdiv12FlrE_6pqvasIlWnKqC3VrcG-ju7HR0cp5eDwcXJ_3rVDMucOqIMjzXWoMoBDfCWAUYXK6EiptoKhhxmDpmBDYuc08kUwA5KG0sB2sE3UD7875T37x2NrRyUgZtq7icbbogQdA8fgoDi3T3Dx03na_jdp9K8CwjpIjqYK60b0Lw1smpLyfKzyRg-RmljFHKryij3Vl07J4m1vzI7-wi2FsAFbSqXMxNl-HXFbhgcbnojuburazs7P-J8nJw-z06nVeUobXvPxXKv0iR0YzL-5uBJMeMPzySY_lAPwDi65bR</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1636577229</pqid></control><display><type>article</type><title>Trends in Kidney Transplant Outcomes in Older Adults</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>McAdams-DeMarco, Mara A. ; James, Nathan ; Salter, Megan L. ; Walston, Jeremy ; Segev, Dorry L.</creator><creatorcontrib>McAdams-DeMarco, Mara A. ; James, Nathan ; Salter, Megan L. ; Walston, Jeremy ; Segev, Dorry L.</creatorcontrib><description>Objectives
To estimate mortality and death‐censored graft loss according to year of kidney transplant (KT) between 1990 and 2011.
Design
Cohort study.
Setting
The Scientific Registry of Transplant Recipients (SRTR).
Participants
KT recipients aged 65 and older at the time of transplantation (N = 30,207).
Measurements
Mortality and death‐censored graft loss ascertained through center report and linkage to Social Security Death Master File and to Medicare.
Results
Older adults currently account for 18.4% of KT recipients, up from 3.4% in 1990; similar increases were noted for deceased donor (5.4 times percentage increase) and live donor (9.1 times percentage increase) transplants. Current recipients are not only older, but also more likely to be female and African American, have lengthier pretransplant dialysis, have diabetes mellitus or hypertension, and receive marginal kidneys. Mortality for older deceased donor recipients between 2009 and 2011 was 57% lower (hazard ratio (HR) = 0.43, 95% confidence interval (CI) = 0.33–0.56, P < .001) than between 1990 and 1993; mortality for older live donor recipients was 50% lower (HR = 0.50, 95% CI = 0.36–0.68, P < .001). Death‐censored graft loss for older deceased donor recipients between 2009 and 2011 was 65% lower (HR = 0.35, 95% CI = 0.29–0.42, P < .001) than between 1990 and 1993; death‐censored graft loss for older live donor recipients was 59% lower (HR = 0.41, 95% CI = 0.24–0.70, P < .001).
Conclusion
Despite a major increase in number of older adults transplanted and an expanding window of transplant eligibility, mortality and graft loss have decreased substantially for this recipient population. These trends are important to understand for patient counseling and transplant referral.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.13130</identifier><identifier>PMID: 25439325</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Hoboken, NJ: Blackwell Publishing Ltd</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Epidemiology ; Female ; General aspects ; Geriatrics ; graft loss ; Graft Rejection - mortality ; Humans ; kidney transplantation ; Kidney Transplantation - mortality ; Kidneys ; Male ; Medical sciences ; mortality ; older adults ; Outcome Assessment (Health Care) - trends ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Registries ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Surgical outcomes ; Survival Analysis ; Transplants & implants ; United States - epidemiology</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2014-12, Vol.62 (12), p.2235-2242</ispartof><rights>2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society</rights><rights>2015 INIST-CNRS</rights><rights>2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.</rights><rights>2014 American Geriatrics Society and Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4560-f2ad58ccc16965d6dea101f8a6a012c3642f03f4d60df7fb27a1181acde51ed63</citedby><cites>FETCH-LOGICAL-c4560-f2ad58ccc16965d6dea101f8a6a012c3642f03f4d60df7fb27a1181acde51ed63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=29094010$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25439325$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McAdams-DeMarco, Mara A.</creatorcontrib><creatorcontrib>James, Nathan</creatorcontrib><creatorcontrib>Salter, Megan L.</creatorcontrib><creatorcontrib>Walston, Jeremy</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><title>Trends in Kidney Transplant Outcomes in Older Adults</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Objectives
To estimate mortality and death‐censored graft loss according to year of kidney transplant (KT) between 1990 and 2011.
Design
Cohort study.
Setting
The Scientific Registry of Transplant Recipients (SRTR).
Participants
KT recipients aged 65 and older at the time of transplantation (N = 30,207).
Measurements
Mortality and death‐censored graft loss ascertained through center report and linkage to Social Security Death Master File and to Medicare.
Results
Older adults currently account for 18.4% of KT recipients, up from 3.4% in 1990; similar increases were noted for deceased donor (5.4 times percentage increase) and live donor (9.1 times percentage increase) transplants. Current recipients are not only older, but also more likely to be female and African American, have lengthier pretransplant dialysis, have diabetes mellitus or hypertension, and receive marginal kidneys. Mortality for older deceased donor recipients between 2009 and 2011 was 57% lower (hazard ratio (HR) = 0.43, 95% confidence interval (CI) = 0.33–0.56, P < .001) than between 1990 and 1993; mortality for older live donor recipients was 50% lower (HR = 0.50, 95% CI = 0.36–0.68, P < .001). Death‐censored graft loss for older deceased donor recipients between 2009 and 2011 was 65% lower (HR = 0.35, 95% CI = 0.29–0.42, P < .001) than between 1990 and 1993; death‐censored graft loss for older live donor recipients was 59% lower (HR = 0.41, 95% CI = 0.24–0.70, P < .001).
Conclusion
Despite a major increase in number of older adults transplanted and an expanding window of transplant eligibility, mortality and graft loss have decreased substantially for this recipient population. These trends are important to understand for patient counseling and transplant referral.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Epidemiology</subject><subject>Female</subject><subject>General aspects</subject><subject>Geriatrics</subject><subject>graft loss</subject><subject>Graft Rejection - mortality</subject><subject>Humans</subject><subject>kidney transplantation</subject><subject>Kidney Transplantation - mortality</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>mortality</subject><subject>older adults</subject><subject>Outcome Assessment (Health Care) - trends</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Registries</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Surgical outcomes</subject><subject>Survival Analysis</subject><subject>Transplants & implants</subject><subject>United States - epidemiology</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNp10ElLxDAYBuAgio7LwT8gBRH0UM2Xre1xFB03nIMjipcQs0jHTjsmLTr_3uiMCoK55JDnW_IitA34EOI5Gj-HQ6BA8RLqAack5Qz4MuphjEmaC2BraD2EMcZAcJ6vojXCGS0o4T3ERt7WJiRlnVyVprazZORVHaaVqttk2LW6mdiv12FlrE_6pqvasIlWnKqC3VrcG-ju7HR0cp5eDwcXJ_3rVDMucOqIMjzXWoMoBDfCWAUYXK6EiptoKhhxmDpmBDYuc08kUwA5KG0sB2sE3UD7875T37x2NrRyUgZtq7icbbogQdA8fgoDi3T3Dx03na_jdp9K8CwjpIjqYK60b0Lw1smpLyfKzyRg-RmljFHKryij3Vl07J4m1vzI7-wi2FsAFbSqXMxNl-HXFbhgcbnojuburazs7P-J8nJw-z06nVeUobXvPxXKv0iR0YzL-5uBJMeMPzySY_lAPwDi65bR</recordid><startdate>201412</startdate><enddate>201412</enddate><creator>McAdams-DeMarco, Mara A.</creator><creator>James, Nathan</creator><creator>Salter, Megan L.</creator><creator>Walston, Jeremy</creator><creator>Segev, Dorry L.</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201412</creationdate><title>Trends in Kidney Transplant Outcomes in Older Adults</title><author>McAdams-DeMarco, Mara A. ; James, Nathan ; Salter, Megan L. ; Walston, Jeremy ; Segev, Dorry L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4560-f2ad58ccc16965d6dea101f8a6a012c3642f03f4d60df7fb27a1181acde51ed63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Epidemiology</topic><topic>Female</topic><topic>General aspects</topic><topic>Geriatrics</topic><topic>graft loss</topic><topic>Graft Rejection - mortality</topic><topic>Humans</topic><topic>kidney transplantation</topic><topic>Kidney Transplantation - mortality</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>mortality</topic><topic>older adults</topic><topic>Outcome Assessment (Health Care) - trends</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Registries</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Surgical outcomes</topic><topic>Survival Analysis</topic><topic>Transplants & implants</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McAdams-DeMarco, Mara A.</creatorcontrib><creatorcontrib>James, Nathan</creatorcontrib><creatorcontrib>Salter, Megan L.</creatorcontrib><creatorcontrib>Walston, Jeremy</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McAdams-DeMarco, Mara A.</au><au>James, Nathan</au><au>Salter, Megan L.</au><au>Walston, Jeremy</au><au>Segev, Dorry L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trends in Kidney Transplant Outcomes in Older Adults</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2014-12</date><risdate>2014</risdate><volume>62</volume><issue>12</issue><spage>2235</spage><epage>2242</epage><pages>2235-2242</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>Objectives
To estimate mortality and death‐censored graft loss according to year of kidney transplant (KT) between 1990 and 2011.
Design
Cohort study.
Setting
The Scientific Registry of Transplant Recipients (SRTR).
Participants
KT recipients aged 65 and older at the time of transplantation (N = 30,207).
Measurements
Mortality and death‐censored graft loss ascertained through center report and linkage to Social Security Death Master File and to Medicare.
Results
Older adults currently account for 18.4% of KT recipients, up from 3.4% in 1990; similar increases were noted for deceased donor (5.4 times percentage increase) and live donor (9.1 times percentage increase) transplants. Current recipients are not only older, but also more likely to be female and African American, have lengthier pretransplant dialysis, have diabetes mellitus or hypertension, and receive marginal kidneys. Mortality for older deceased donor recipients between 2009 and 2011 was 57% lower (hazard ratio (HR) = 0.43, 95% confidence interval (CI) = 0.33–0.56, P < .001) than between 1990 and 1993; mortality for older live donor recipients was 50% lower (HR = 0.50, 95% CI = 0.36–0.68, P < .001). Death‐censored graft loss for older deceased donor recipients between 2009 and 2011 was 65% lower (HR = 0.35, 95% CI = 0.29–0.42, P < .001) than between 1990 and 1993; death‐censored graft loss for older live donor recipients was 59% lower (HR = 0.41, 95% CI = 0.24–0.70, P < .001).
Conclusion
Despite a major increase in number of older adults transplanted and an expanding window of transplant eligibility, mortality and graft loss have decreased substantially for this recipient population. These trends are important to understand for patient counseling and transplant referral.</abstract><cop>Hoboken, NJ</cop><pub>Blackwell Publishing Ltd</pub><pmid>25439325</pmid><doi>10.1111/jgs.13130</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0002-8614 |
| ispartof | Journal of the American Geriatrics Society (JAGS), 2014-12, Vol.62 (12), p.2235-2242 |
| issn | 0002-8614 1532-5415 |
| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Aged Aged, 80 and over Biological and medical sciences Epidemiology Female General aspects Geriatrics graft loss Graft Rejection - mortality Humans kidney transplantation Kidney Transplantation - mortality Kidneys Male Medical sciences mortality older adults Outcome Assessment (Health Care) - trends Public health. Hygiene Public health. Hygiene-occupational medicine Registries Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Surgical outcomes Survival Analysis Transplants & implants United States - epidemiology |
| title | Trends in Kidney Transplant Outcomes in Older Adults |
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