Background

Low likelihood of listing and subsequent deceased donor transplantation has previously been reported for the elderly with additional concerns about patient frailty, morbidity and mortality in those transplanted successfully. We analysed transplantation and patient survival rates for those aged 70 years or more listed on the deceased donor waiting list (DDWL) between 2004 and 2014. Additional analysis was made of post transplant outcomes.

Methods

We identified adults aged >70 years in a large single UK transplant centre successfully listed on the DDWL June 2004-May 2014. All individuals were followed with analysis made of patient survival, transplantation and wait list status and patient and graft outcomes after transplantation.

Results

We identified 171 patients, mean age 73 years, successfully listed on the DDWL June 2004 to May 2014 and followed for a mean of 36 months (SD 31). At time of last f/up kidney transplantation occurred successfully in 26 (15%). 53 (31%) were still active on the WL, 26 (15%) were suspended and 32 (19%) were removed from the WL while 34 (20%) had died. Overall survival after listing was 74% at 1 year and 23% at 5 years. Transplantation conferred a significant survival benefit (p=0.014) with 1 year survival 99% v 92% (WL) and 5 year survival 83% v 60%. Transplanted patients had a mean age at listing of 73 years. Median length of stay post transplant was 9 days (R 6-39) and median GFR at discharge 38.6 ml/min and at 1 year 38.4 ml/min. After a median follow up post transplant of 35 months (R: 1.7-112) 21/26 (81%) patients were alive with functioning grafts, 3 had died and 2 experienced graft failure.

Conclusions

For those aged 70 years and over entering the transplant wait list, subsequent transplantation confers a significant survival benefit to remaining on the waiting list.

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