There are more people over the age of 65
on dialysis than ever before. As our population continues
to age, that number is only expected to rise. The good
news is that scientific data compiled over the last several
years reveals that more senior citizens with renal disease
are improving their quality of life with kidney transplantation.
The prospect of kidney transplantation
in a person over the age of 65 raises three major considerations
that patients and their nephrologists should explore together.
There are important medical considerations for elderly
transplant candidates, ethical issues to ponder and unique
post transplant considerations that can affect the success
and longevity of their transplant.
With age comes an increased risk for heart disease. For people
on dialysis, the risk of cardiovascular disease is even
greater. The lengthy transplant surgery puts stress on
the heart. And finally, the immunosuppressive drugs required
after the transplant to maintain the organ can cause
side effects to the heart. It is, therefore, very important
for older patients to undergo extensive cardiac testing
that will evaluate the condition of their heart. The
testing may include cardiac catheterization, exercise
stress testing and even peripheral circulatory testing
to ensure that circulation to all their organs and limbs
is satisfactory and will support the transplanted kidney.
Older transplant candidates must also be
screened for cancer. Gastrointestinal screening and colonoscopy,
prostate cancer screening for men and breast and gynecologic
cancer testing for women are all essential. Bladder dysfunction
often accompanies an extended period on dialysis. Urologic
testing is sometimes required to assure that the bladder
will be able to respond to high post-transplant urine flow.
While some patients view these preliminary
screening tests as a nuisance, they are nonetheless crucial
steps in the transplant process that help to prevent serious
complications during or after surgery. Naturally, we want
all kidney transplant recipients to enjoy the full potential
of the organ they receive.
In the United States anyone who has advanced renal failure
has the right to be considered for transplantation, regardless
of age. Once any person is listed as a transplant candidate,
their age plays no part in determining their position
on that list. Generally, I recommend that all people
over the age of 65 consider transplantation, visit a
transplant center to educate themselves about the alternative
and undergo transplant evaluation.
Some professionals and ethicists raise
moral and ethical issues surrounding transplantation in
the elderly because of the limited life span verses younger
candidates, say in their 30s or 40s. Yet, I have seen many
patients in their 70s and even 80s do very well and enjoy
full, active lives following transplantation. As physicians,
we must consider the patients' physiological age rather
than their chronological age.
The post-transplant survival statistics for elderly patients
are good and getting better, thanks to advances in surgical
techniques and new immunosuppressive drug protocols.
The risk of infection is greater for older people, so
patients and their nephrologists must manage the post
surgical course very carefully, balancing the risk of
infection with the risk of organ rejection. Recent studies
now indicate that elderly patients actually do well with
less immunosuppressive medication because their immune
systems are turned down a little due to age.
Another way for elderly patients to maximize
the benefit of transplantation is to see their primary
care physician annually and continue to maintain their
overall health.
The truth of the matter is that kidney transplantation gives
a greater chance for survival than dialysis, regardless of
age. Seniors owe it to themselves to explore all of their
living donor options, whether related or non-related. If
elderly patients are properly evaluated and screened at an
expert transplant center, there is every reason to believe
that they will enjoy a good quality of life after transplantation.
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