27 research outputs found
Randomized trial of misoprostol in patients with chronic renal transplant rejection
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Randomized trial to evaluate the use of increasing the steroid dose during conversion from cyclosporine to azathioprine
Combined pancreas and kidney transplantation improves survival in patients with end-stage diabetic nephropathy
Conversion from cyclosporine A to azathioprine treatment improves LDL oxidation in kidney transplant recipients
Conversion from cyclosporine A to azathioprine treatment improves LDL oxidation in kidney transplant recipients
Tapering immunosuppressive therapy significantly improves in vivo cutaneous delayed type hypersensitivity responses
The vanishing importance of age in renal transplantation
Background . The growing number of patients awaiting a kidney transplant raises questions about allocation of kidneys to the elderly and about the use of elderly donors. In all reported studies analyzing the influence of age on the outcome after renal transplantation, age is investigated as a categorical variable. Methods . We studied age both as a categorical (Kaplan-Meier) and as a continuous (Cox) variable in a total of 509 cyclosporine-treated recipients of a primary cadaveric kidney graft who underwent transplantation between July 1983 and July 1997. For the Kaplan-Meier analysis, the population was divided into three comparably sized age groups: 17-43 years (n=171), 44-55 years (n=169), and 56-75 years (n=169). Results . Patient survival was better and graft survival censored for death was worse in the younger patients. Overall graft survival (end point was death or graft failure) was not significantly influenced by age. In the Cox proportional hazards analysis, transplantation year turned out to be an important, independent variable influencing all end points. Because the influence was not linear, three periods were defined in which the relative risk remained stable: 19831990, 1991-1993, and 1994-1997. In the second period, the relative risk for transplant failure or death was 49% of that in the first period. In the third period, the relative risk had decreased to 22% of that in the first period. Recipient age and donor age were significant predictors of overall transplant failure. There was no interaction between these variables and transplantation year. Within each transplantation period, an increase in recipient age by 1 year increased the relative risk for overall graft failure by only 1.44%. The influence of donor age followed a J-shaped curve with a minimum at 30 years. The influence of increasing either recipient or donor age was counteracted by the improving results over time. Conclusion . Considering the improving results over time, there are, at this moment, no arguments for an age restriction for kidney transplant recipients or donors