AJT Editorial: The Graying of Organ Transplantation

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2012.04246.x/full

Editorial
The Graying of Organ Transplantation
D. R. Goldstein
American Journal of Transplantation
Volume 12, Issue 10, pages 2569–2570, October 2012

Throughout the world, the number of older people over 65 years of age is increasing. Indeed, by year 2050 the number of older people will likely eclipse the number of younger (<35 years of age) people for the first time (1). Hence, the medical needs of older people will dominate the health care agenda for the foreseeable future.

The aging of our society is having an increasingly large impact on organ transplantation. In particular, the number of older people receiving organ transplants, including renal, cardiac, liver and lung, is increasing. Specifically, recipients >60 years of age represent 20% of those receiving heart transplants (2), and similar rates have been observed in kidney transplantation. Furthermore, outcomes after organ transplantation in older people selected for transplantation are favorable. According to the International Society for Heart and Lung Transplantation, heart transplant recipients in the 60–69-year-old age cohort exhibit a similar 5-year survival to patients in the 18–39-year-old cohort (2). Similar findings have been noted for lung and kidney transplantation. Importantly, patients who receive a heart transplant in their sixties have a greater than 50% probability of living into their 8th decade with chronic immune suppression (2).

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[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2012.04245.x/abstract

Meeting Report
Solid-Organ Transplantation in Older Adults: Current Status and Future Research
American Journal of Transplantation
Volume 12, Issue 10, pages 2608–2622, October 2012

Abstract
An increasing number of patients older than 65 years are referred for and have access to organ transplantation, and an increasing number of older adults are donating organs. Although short-term outcomes are similar in older versus younger transplant recipients, older donor or recipient age is associated with inferior long-term outcomes. However, age is often a proxy for other factors that might predict poor outcomes more strongly and better identify patients at risk for adverse events. Approaches to transplantation in older adults vary across programs, but despite recent gains in access and the increased use of marginal organs, older patients remain less likely than other groups to receive a transplant, and those who do are highly selected. Moreover, few studies have addressed geriatric issues in transplant patient selection or management, or the implications on health span and disability when patients age to late life with a transplanted organ. This paper summarizes a recent trans-disciplinary workshop held by ASP, in collaboration with NHLBI, NIA, NIAID, NIDDK and AGS, to address issues related to kidney, liver, lung, or heart transplantation in older adults and to propose a research agenda in these areas.