Nephrol Dial Transplant (2004) 19: 945-951
Nephrol Dial Transplant Vol. 19 No. 4 © ERA-EDTA 2004; all rights reserved
Original Article
How great is the survival advantage of transplantation over dialysis in elderly patients?
1Transplant Unit, The Royal Infirmary, Edinburgh and 2Information and Statistics Division, NHS Scotland, Edinburgh, UK
Correspondence and offprint requests to: Mr John Forsythe, The Royal Infirmary of Edinburgh, 1 Lauriston Place, Edinburgh EH3 9YW, UK. Email: john.forsythe{at}luht.scot.nhs.uk
Background. Patients >60 years old represent 66% of all new patients starting renal replacement therapy in Scotland. The aim of this study was to investigate whether or not transplantation provides any survival benefit in this group of patients.
Methods. 325 patients >60 years old listed for transplantation in Scotland between 1 January 1989 and 31 December 1999 were followed up until 31 December 2000. Sociodemographic, comorbidity, listing and transplant data were obtained from the national renal and transplant databases and case-notes review. Survival was compared between those who received a transplant and those who were listed but did not receive a transplant by the end of the follow-up period. Mann-Whitney, 
2, Fisher's exact and log-rank tests were used where appropriate.
Results. Of the 325 patients listed, 128 (39.4%) received a first transplant within the study period and the remaining 197 (60.6%) continued to undergo dialysis. The transplant recipients were younger at listing (P<0.0001), lived closer to the transplant centre (P = 0.043) and spent less time on the active waiting list (P<0.0001) than patients who remained on dialysis. They had less ischaemic heart disease (P = 0.024), cerebrovascular disease (P = 0.03) and arrhythmias (P = 0.016). The overall mortality rate was 0.16 per patient-year for dialysis and 0.10 for transplantation. There was a significantly lower risk of death (RR = 0.35, 95% CI 0.22–-0.54; P<0.0001, log-rank) and a longer life expectancy after listing with a transplant (8.17 vs 4.32 years).
Conclusions. Renal transplantation offers a significant survival advantage over dialysis in elderly patients with end-stage renal failure who are considered suitable for transplantation.
Keywords: comorbidity; dialysis; elderly patient; patient survival; renal transplantation survival; survival on dialysis
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