Publication
Title
Immunosuppression in the elderly renal allograft recipient : a systematic review
Author
Institution/Organisation
DESCARTES Working Group
DESCARTES ERA-EDTA Board
Abstract
Background The Elderly are the fastest growing part of kidney transplant recipients. The best immunosuppressive strategy is unknown. Methods We performed a systematic search of randomized controlled trials and observational studies focused on safety and efficacy of different immunosuppression strategies in elderly kidney recipients. Data extraction and risk of bias evaluation were systematically performed. Results Ten studies were included: 2 randomized clinical trials and 8 observational. A marginal benefit was found for early renal function with delayed tacrolimus or complete tacrolimus avoidance using mycophenolate mofetil (MMF). Observational cohort studies looked at different antibody induction strategies, calcineurin-inhibitors based maintenance immunosuppression, calcineurin-inhibitor-free sirolimus-based therapy and use of MMF versus azathioprine. Treatment with interleukin-2 receptor antibody induction, calcineurin-inhibitor minimization with MMF and steroid minimization is advisable in the low immunologic risk elderly recipient, considering the increased risk of toxicities, infection and malignancies. In the high immunologic risk elderly recipient, taking into account the morbid consequences of acute rejection in the elderly, observational studies support antibody induction with depletive antibodies, calcineurin-inhibitor, MMF and steroids; calcineurin-inhibitor-minimization is not recommended. Conclusions There is very limited evidence for the benefits and harms of different immunosuppression strategies in the elderly. Most of the published literature are observational studies, and randomized controlled trials are urgently needed.
Language
English
Source (journal)
Transplantation reviews. - Orlando, Fla
Publication
Orlando, Fla : 2016
ISSN
0955-470X
Volume/pages
30(2016), p. 144-153
ISI
000378369600002
Full text (Publishers DOI)
Full text (open access)
The author-created version that incorporates referee comments and is the accepted for publication version Available from 01.07.2017
Full text (publishers version - intranet only)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identification
Creation 21.06.2016
Last edited 06.05.2017
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