GA: Is kidney transplantation for everyone? The example of the older dialysis patient

For the average patient with ESRD, kidney transplantation improves quality of life and prolongs survival compared with patients who are on the transplant waiting list and remain on dialysis. Despite the proven benefits, some patient populations, such as those of older age, may not be referred and accepted for kidney transplantation to the same extent as younger patients. The population with ESRD is aging. Nearly half of all new patients are older than 65 yr. Nephrologists and transplant surgeons will need to make more and more decisions regarding transplantation referral and candidacy in this population. This article reviews the data on survival, quality of life, and cost-effectiveness of kidney transplantation in the older dialysis patient. Clinical guidelines and data on current practice are also reviewed. Clin J Am Soc Nephrol 4: 2040–2044, 2009. doi: 10.2215/CJN.04210609 T he principal goals of kidney transplantation are to im-prove health-related quality of life and prolong sur-vival. For the average patient with ESRD, the evidence to date confirms that these objectives are being achieved (1–3). In addition, from the perspective of the health care system, it would be ideal if these treatment goals were achieved in a cost-effective manner. Again, for the average patient, kidney transplantation is both less costly and more effective than the alternative of remaining on dialysis (1). Few health care tech