Long-term outcomes of kidney transplantation in recipients 60 years of age and older at the University of Florida.
ABSTRACT As the population ages, the transplant community will continue to see "elderly" patients with end-stage kidney disease who are seeking transplantation. In this report we describe long-term outcomes of 315 primary kidney transplants performed at the University of Florida in recipients aged > or = 60 years and compare them to results from 3 younger recipient cohorts. Among recipients > or = 60 years, patient survival was significantly worse than for younger recipients but no differences in graft or death-censored graft survival were seen. We suspect that although patient survival was worst in the oldest group, there were likely other causes of graft loss within the younger groups that balanced the effects of death on graft survival in the oldest group. Among recipients aged > or = 60 years, patient survival at 10 years was 55% for living-donor kidney recipients and 46% for deceased-donor kidney recipients. African-American recipients had a higher risk of mortality and graft loss in all age groups after deceased donor kidney transplantation but not after living donor transplantation. Delayed graft function negatively impacted outcomes among all recipients and the adverse effects were greater after deceased donor than living donor transplantation. These effects were also seen within the oldest recipient age group. Increased donor age was a significant risk factor for death and graft loss among all age groups after deceased donor kidney transplantation but not among living-donor kidney recipients. More specifically, recipients aged > or = 60 years who received kidneys from donors > or = 60 years demonstrated significantly worse outcomes when compared to those receiving donor kidneys < 60 years. The presence of diabetes mellitus in recipients > or = 60 years was not a significant risk factor for mortality or graft loss after transplantation. Acceptable results can be obtained after kidney transplantation in recipients aged > or = 60 years. Future investigations should focus on improving recipient selection in the elderly population, identifying strategies to minimize DGF in deceased donor kidneys, understanding all variables involved in the risk associated with recipient race, and increasing living donor transplantation across all age groups.
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ABSTRACT: El objetivo de este trabajo fue identifi car los problemas de enfermería en la atención a pacientes añosos (a partir de 65 años), receptores de injerto renal durante su ingreso hospitalario para el trasplante. Para ello se analizaron retrospectivamente las historias clínicas de los años 2005 y 2006, codificándose los problemas de enfermería mediante la Taxonomía NANDA. Se utilizó la estadística descriptiva para mostrar la frecuencia y duración de los problemas, así como la presencia de complicaciones médicas. También se contabilizaron el número de transfusiones sanguíneas, número de hemodiálisis post-trasplante y el número de pacientes que precisaron de suero de irrigación continua vesical para tratar los problemas de coágulos intravesicales. Los problemas de enfermería más frecuentes son: riesgo de infección, riesgo de lesión perioperatoria, exceso de volumen de líquidos, deterioro de la integridad cutánea, deterioro de la movilidad física, déficit de autocuidados, conocimientos deficientes y deterioro del patrón del sueño. Los problemas que, al alta, quedaron sin resolver de forma más frecuente fueron deterioro de la eliminación urinaria, conocimientos deficientes, riesgo de glucemia inestable y deterioro del patrón del sueño. Las complicaciones médicas más frecuentes fueron la necrosis tubular aguda y la fístula urinaria. El 23% de los pacientes necesitaron transfusiones de sangre post-cirugía, el 45% necesitó de hemodiálisis en los días posteriores al trasplante y el 38% necesitó de irrigación continua vesical.Revista de la Sociedad Espanola de Enfermeria Nefrologica 01/2009; 12(4).
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ABSTRACT: Many transplant studies in elderly patients focus on survival and mortality rates. It was the aim of this review to evaluate publications dealing with individual patient performance and independence. The literature search included all articles retrievable for the hit "transplantation in elderly recipients" between 1960 and 2010. For quality search the inclusion criteria were as follows: older than 60 years and transplanted kidney, liver, heart, lung or pancreas from a deceased or living donor. We focussed on parameters concerning quality of life, frailty, nutritional status/weight loss, drugs/interactions/polypharmacy, gait/osteoporosis/fracture, delirium/dementia and geriatric assessment to address physical and psychosocial functionality of elderly recipients. The initial hit list contained 1427 citations from electronic databases. 249 abstracts thereof were selected for full review. A total of 60 articles met final inclusion criteria. Finally, only five studies met the qualitative inclusion criteria as listed above. The number of elderly patients placed on waiting lists has increased dramatically and will further grow. Interdisciplinary collaboration and distinct patient selection is recommended in most of the studies. However, data concerning quality of life and related parameters in elderly transplant recipients are rare.Ageing research reviews 07/2011; 11(1):181-7. · 7.63 Impact Factor
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ABSTRACT: Patients with bilateral multifocal renal cell carcinoma are at increased risk of developing locally recurrent or de novo tumors after nephron-sparing procedures. When dealing with recurrent renal masses the options are limited to observation, total nephrectomy, ablation, or repeat surgical intervention. The main reason for recurrence after nephron-sparing surgery is likely to be the presence of multifocal disease, which is identified in 4.3-25.0% of radical nephrectomy specimen. Bilateral renal involvement is seen in almost 90% of cases of multifocal renal carcinoma, and conversely the majority of patients with bilateral disease will have multifocal tumors. Many patients who are treated for multifocal disease, therefore, require subsequent surgical interventions. The outcome data for repeat renal interventions demonstrate reasonable functional and oncologic outcomes despite higher rates of perioperative complications. Our own results support the use of reoperative renal surgery rather than total nephrectomy and renal replacement therapy.Nature Reviews Urology 05/2010; 7(5):267-75. · 4.79 Impact Factor