[Editorial Comments by Dr. Ann M. O'Hare, pp 151–153]
Candidacy for Kidney Transplantation of Older Adults
Version of Record online: 12 JAN 2012
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 60, Issue 1, pages 1–7, January 2012
How to Cite
Grams, M. E., Kucirka, L. M., Hanrahan, C. F., Montgomery, R. A., Massie, A. B. and Segev, D. L. (2012), Candidacy for Kidney Transplantation of Older Adults. Journal of the American Geriatrics Society, 60: 1–7. doi: 10.1111/j.1532-5415.2011.03652.x
- Issue online: 12 JAN 2012
- Version of Record online: 12 JAN 2012
- National Institutes of Health. Grant Number: T32 DK 007732–15
- NIH. Grant Number: K23AG032885
- American Federation of Aging Research. Grant Number: R21DK085409
- kidney transplantation;
- older adults;
- risk prediction;
- transplant outcomes
To develop a prediction model for kidney transplantation (KT) outcomes specific to older adults with end-stage renal disease (ESRD) and to use this model to estimate the number of excellent older KT candidates who lack access to KT.
Secondary analysis of data collected by the United Network for Organ Sharing and U.S. Renal Disease System.
Retrospective analysis of national registry data.
Model development: Medicare-primary older recipients (aged ≥ 65) of a first KT between 1999 and 2006 (N = 6,988). Model application: incident Medicare-primary older adults with ESRD between 1999 and 2006 without an absolute or relative contraindication to transplantation (N = 128,850).
Comorbid conditions were extracted from U.S. Renal Disease System Form 2728 data and Medicare claims.
The prediction model used 19 variables to estimate post-KT outcome and showed good calibration (Hosmer–Lemeshow P = .44) and better prediction than previous population-average models (P < .001). Application of the model to the population with incident ESRD identified 11,756 excellent older transplant candidates (defined as >87% predicted 3-year post-KT survival, corresponding to the top 20% of transplanted older adults used in model development), of whom 76.3% (n = 8,966) lacked access. It was estimated that 11% of these candidates would have identified a suitable live donor had they been referred for KT.
A risk-prediction model specific to older adults can identify excellent KT candidates. Appropriate referral could result in significantly greater rates of KT in older adults.