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  • Title: Survival of transplanted and dialysed patients in a French region with focus on outcomes in the elderly.
    Author: Bayat S, Kessler M, Briançon S, Frimat L.
    Journal: Nephrol Dial Transplant; 2010 Jan; 25(1):292-300. PubMed ID: 19749147.
    Abstract:
    BACKGROUND: Impact of kidney transplantation on survival of French end-stage renal disease (ESRD) patients is unknown. METHODS: A total of 1495 adults living in the Lorraine region and starting renal replacement therapy from 1997 to 2003 were included. A propensity score (PS) of registration on the renal transplant waiting list was estimated. Patient survival was studied using a time-dependent Cox multivariate regression and a Cox model stratified by PS tertiles. Survival of older patients (> or =60 years) was detailed. RESULTS: Survival was associated with age, medical factors and transplantation. The hazard ratio (HR) of death for patients on dialysis compared to transplant recipients was 4.6 (95% CI: 2.9-7.2). The survival analysis stratified by PS was similar to the multivariate Cox model. The survival benefit of transplantation over dialysis persisted among elderly patients [HR: 4.6 (95% CI: 2.2-9.7)]. CONCLUSIONS: In a French community-based network, after taking into account comorbidities, transplantation was associated with longer survival even among elderly patients. Age per se should not therefore be considered as a contraindication to renal transplantation. However, elderly patients should be evaluated carefully before registration on the list. Medical guidelines should put forward a standard set of criteria for access to renal transplantation.
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