From Our 2009 Archives

Almost Half of Those Over 60 Die While Waiting for Kidney Transplant

By Serena Gordon
HealthDay Reporter

THURSDAY, June 18 (HealthDay News) -- Nearly one of every two people over the age of 60 who are hoping for a kidney transplant will die while on the waiting list, new research shows.

The study also found that other factors, such as having diabetes, being black, having certain blood types, being older than 70, or waiting for a transplant in certain areas of the country increased the odds that someone would die while waiting for a donated kidney.

"The prognosis, particularly for older patients waiting for a kidney transplant, has deteriorated rapidly over the past decade," said study author Jesse Schold, an assistant professor of medicine at the University of Florida in Gainesville.

"Wait-list times have increased, but the rate of transplant hasn't increased markedly," he explained, adding that this leaves "older candidates at a significantly greater risk, because they have a higher risk of mortality in general."

Results of the study were published in the June 18 online edition of the Clinical Journal of the American Society of Nephrology.

Schold said the findings emphasize the need for people to get on transplant waiting lists immediately. "If you know this is something you're interested in, get on a waiting list before you even start dialysis, if possible," he advised.

Dr. Robert Provenzano, chief of nephrology for St. John Hospital and Medical Center in Detroit, agreed that people should get on a waiting list as soon as possible and consider getting on the waiting list at more than one medical center to improve the odds of getting a donated kidney.

The current study looked at data from 1995 through 2007 and included 54,669 candidates who were older than 60 and on a waiting list for a kidney transplant.

Of those listed in 2006 and 2007, the researchers projected that 46% would die while on the waiting list. In 1995, that number was just 22%, according to the study. Those over 70 fared even worse, with 52% expected to die before receiving a kidney transplant.

The researchers found a wide disparity -- from 6% to 81% -- in the risk of dying while on the waiting list from region to region. The areas with the lowest death rates while on the waiting list include Alaska, Hawaii, Idaho, Montana, Oregon and Washington. Areas with the highest deaths for people over 60 while on the kidney transplant list include California, Arizona, Nevada, New Mexico and Utah.

The study also found a racial disparity, with 62% of blacks expected to die while waiting for a kidney transplant. Schold said that it can be harder for blacks to find a good matching donor under the current allocation system, and that donations tend to be lower within minority groups. But, he added, these factors are improving.

Other factors that increased the rate of death while on the transplant list included having blood type B or O, having diabetes, or already being on dialysis at the time you're put on the transplant list.

Both Schold and Provenzano said the findings highlight the need to reach out more to living donors, because the need for donated kidneys far exceeds the number of donations obtained from the deceased. Even if your loved one isn't an exact match, it's possible your doctor may be able to find a paired donation in which your willing donor gives his or her kidney to someone else, and that person's loved one gives his or her kidney to you. Recently, some medical centers have created living donor chains that have an even greater potential to increase the number of transplants.

"Be proactive in navigating the steps needed to get a transplant, and consider the center that's in your best interest. You have choices," Schold said.

Provenzano also said it's critical to "take care of yourself. Sometimes people on dialysis continue to be their own worst enemy by pushing off dialysis appointments. But, the more dialysis, the better. If you can get on night-time dialysis or home dialysis, you'll probably do significantly better."

SOURCES: Jesse D. Schold, Ph.D., assistant professor of medicine, University of Florida, Gainesville; Robert Provenzano, M.D., chief, nephrology, St. John Hospital and Medical Center, Detroit; June 18, 2009, Clinical Journal of the American Society of Nephrology, online

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