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23-01-2012 | Surgery | Article

Senior citizens denied access to lifesaving kidney transplants

Abstract

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MedWire News: American senior citizens fall victim to "outdated medical biases" surrounding kidney transplantation, according to a study in the Journal of the American Geriatrics Society.

Researchers at John Hopkins University in Baltimore, Maryland, USA, estimated that between 1999 and 2006, 11,756 patients over 65 years of age were identified as "excellent" transplant candidates but only 13% received a transplant. Adults of this age account for almost half the population with end-stage renal disease, say the researchers.

The study involved 128,850 Medicare-primary patients over 65 years of age with end-stage renal disease and without a contraindication to transplant.

"Doctors routinely believe and tell older people they are not good candidates for kidney transplant, but many of them are if they are carefully selected and if factors that really predict outcomes are fully accounted for," said Dorry Segev, the study's lead author, in a press release.

An additional barrier to transplant is the lack of resources available to enable doctors to make risk-benefit calculations specific to older patients, explains the research team.

In this study, the researchers tested a predictive model on its ability to estimate post-kidney transplant outcome in 6988 patients. The model included 19 variables, such as congestive heart failure, cardiac arrhythmia, complicated diabetes, and chronic pulmonary disease.

After finding the model had good calibration and better predictive power than previous models, the team applied it to the whole 7-year cohort to identify "excellent" kidney transplant candidates. They defined "excellence" as having a 3-year post-kidney transplant survival rate of over 87%, corresponding to the top 20% of the transplanted older adults used in the model development.

Using this model, 76% of the cohort was predicted to have "excellent" outcomes after kidney transplant. Also, 11% of these patients would have been able to undergo live-donor kidney transplantation had they been referred, which the researchers say results in "better individual patient survival without exacerbating the national organ shortage."

Segev describes the current attitude towards transplantation in older adults as "regressive."

The paper by Segev and team concludes: "Access to transplantation is poor in this population, in part because of the difficulty in selecting appropriate candidates. The present study proposes a simple yet accurate subgroup-specific risk prediction model by which older transplantation candidates might be identified."

By Chloe McIvor

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