Member's paper - Kidney Health Education and Research Group

Abstract

Is Age a Potential Barrier to Pursuing Living Donor Kidney Transplant (LDKT)?

Afsaneh Raissi , HBSc1, Nathaniel Edwards, HBSc1, Yu-Ying Liao, HBSc in progress1, Dmitri Belenko, BScN1, Navneet Singh, HBSc1, Maroof Khalid, BMSc1, Deanna Toews, MA,BEd1 and Istvan Mucsi, MD, PhD, FRCPC, FASN1. 1

2018

American Transplant Congress

Full Abstract
Body: Background The incidence of end stage kidney disease (ESKD) among older adults (65+) is increasing. Living Donor Kidney Transplant (LDKT) may provide improved outcome even for this patient population, since surgery can be better planned and complications and graft outcomes are better with LDKT versus deceased donor transplant. Older individuals, however, may be hesitant to consider this option. We are not aware of recent studies that would systematically assess the association between recipient's age and the readiness of pursuing LDKT. In this cross-sectional study we wanted to determine whether older age is associated with less readiness to pursue LDKT. Methods A convenience sample was recruited from two hospital based dialysis clinics in Canada. Patients were divided into three age categories: ?45, 46-64 and ?65 year, respectively (primary exposure). Readiness to pursue LDKT (primary outcome) and transplant knowledge were assessed using validated questionnaires. Having at least one potential living donor identified and willingness to accept an offer of donation if someone volunteered, served as our secondary outcome measures. Results Out of 385 participants (mean[SD] age=57[13] years, 61% male), 19% were ?45, 49% were 46-64 and 32% were ?65 years old. Patients ?65 years of age (OR=0.26, p<0.001), but not 46-64-year-old participants (OR=0.59, p=0.13), had lower odds to have advanced readiness to pursue LDKT, compared to younger patients. This association remained significant after adjusting for gender, ethnicity, number of immediate family members, education, transplant knowledge and comorbidities (OR=0.35, p=0.01). Both participants ?65 years of age (OR=0.22, p<0.001) and 46-64-year-old patients (OR=0.31, p<0.001) had lower odds to have a potential donor identified and were less willing to accept an offer of donation (OR=0.25, p=0.006 and OR=0.37, p=0.04, for ?65 and 46-64 years of age, respectively), in the multivariable adjusted model. Conclusion Patients ?65 years of age may be less ready to pursue LDKT compared to younger adults. This finding might be in part explained by the age related stereotypes and self-stigma. Further research is needed to determine if education programs tailored to middle aged and older population would increase the access to LDKT for those patients.

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