Age limit for renal transplantation

This transcript was revised on December 7, 2019.

Dr Christine Ribic is an associate professor in the Division of Nephrology at McMaster University.

Is there an age limit for renal transplantation? Can an otherwise healthy 70-year-old patient receive a renal transplant?

Christine Ribic, MD, MSc: The short answer is that age is not a relative contraindication to renal transplantation. In fact, because the fastest growing group of patients with end-stage renal disease is those that are aged 65 years and greater, many patients that require renal transplant are now over the age of 70.

But there are a few things we need to consider. There is always the competing risk of death or the probability of an elderly [recipient] with perhaps multiple comorbidities to be removed from the deceased donor waiting list. What I mean is that if there is a risk of dying on dialysis or the risk of being removed from the deceased donor list because of medical comorbidity is higher than the chances of receiving renal transplantation in that period, then probably they may not be the best candidate.

The second factor we need to consider is perioperative mortality. We know that the risk of death after renal transplantation is about 2.8 times higher in the first few weeks after transplantation. This risk decreases after 3 months. If you have a patient with multiple comorbidities, as many elderly patients have, then the risk of death right after a transplant surgery might be uncharacteristically high, and we may not want to expose them to that risk with renal transplantation.

Age itself is not a contraindication. It is patient-specific, and all comorbidities must be considered.