Complications of Kidney Transplantation in Older People

Introduction

Kidney transplantation is also known as renal transplantation. A kidney transplant is needed for patients suffering from end-stage kidney disease. End-stage kidney disease is caused most commonly by type 2 diabetes and hypertension, and in this disease, kidneys fail to work, and the patients need to be on dialysis. The end-stage renal disease population mostly includes older people. Nearly half of all the patients are older than 65 years, and one-third are older than 70 years. Assessing kidney transplantation for older patients with end-stage renal disease is often challenging and includes more complex issues, such as cognitive impairment, decreased functional status, and frailty, which makes patient selection more difficult.

What Are the Types of Kidney Transplants?

There are two types of kidney transplants-

1. Living Donor - A healthy and fit living person eligible to donate is chosen to donate one of their kidneys to the recipient.

2. Cadaveric Transplant - In this type of transplant, kidneys are procured from brain-dead patients.

What Is the Matching Process in Kidney Transplantation?

During evaluation for a kidney transplant, the recipient will undergo blood tests to determine the blood group (A, B, AB, O) and human leukocyte antigen (HLA). If the recipient's HLA type matches the donor’s HLA type, it is more likely that the recipient’s body will not reject the kidney. The more the recipient’s antigen matches the donor’s antigen, the greater the chance for a successful transplant. Once a donor is identified, the recipient will undergo another test to ensure that the recipient’s antibodies do not attack the donor’s organ. This is done by mixing a small amount of the recipient’s blood with the donor’s blood. The transplant cannot be done if the recipient’s blood forms antibodies in response to the donor’s blood. The transplant can proceed if the recipient’s blood shows no antibody reaction.

How the Patient Is Prepared for Transplantation?

The transplant is scheduled in advance if the kidney is being received from a living donor. The patient’s blood sample is then collected for an antibody test. If it is a negative crossmatch, the patient is cleared for surgery. The transplant is done under general anesthesia, which also involves giving medication to the patient that will put them to sleep. The anesthesia is injected into the body intravenously. After the patient is asleep, a surgeon will proceed with the surgery.

What Factors Influence Infection Risk in Kidney Transplantation?

Some of the factors that influence infection risk are as follows-

1. Pre-Transplant Host Factors - These include underlying medical conditions like diabetes, chronic infections, latent infections, recipients’ pre-existing immunity, and prior medications.

2. Transplant Factors - Organ transplant is the most common site of infection. Other than that, allografts may carry infection, complications in blood transfusion, etc.

3. Immunosuppression - Immunosuppressive agents and additional treatment for rejection episodes are factors that influence infection risk.

What Is the Influence of Age on Mortality?

The age of the recipient can greatly influence the outcome of the transplantation, which is explained below-

1. Co-morbid Conditions- Older patients are more likely to be associated with comorbidities like lung diseases, diabetes, etc., at the time of transplantation which puts them at higher risk of mortality.

2. Cardiovascular Diseases- Cardiovascular disease in the elderly increases the risk of kidney diseases, and it is the most common cause of death in kidney transplant patients.

3. Infectious Diseases- Infection-related mortality is the second most common cause of death in the elderly transplant population.

What Are the Complications of Kidney Transplantation in Older People?

Some of the complications of kidney transplants in older people are explained below-

1. Rejection - Although the older population has a lower rate of kidney rejection, it has a significant impact. As older patients most often receive older donors’ kidneys. Since older patients have less reserve, they may not tolerate aggressive acute rejection therapies because of the increased risk of infection.

2. Immunosuppression - Immune-suppressing medications are used as rejection therapies that work by diminishing the immune cell’s ability to function. Older patients are less tolerant of these, making them more vulnerable to infections. Long-term use of immunosuppressants can have various side effects such as weight gain, increased blood pressure, risk of certain cancers, etc.

3. Abscess - There is a risk of developing an abscess in the abdominal wall, more likely in older and diabetic patients.

4. Weak Abdominal Muscle - Kidney transplantation is an extensive surgery that can weaken the abdominal muscles and may lead to a risk of abdominal hernia over the site of the incision. Older, obese, and diabetic patients are more at risk.

5. Allograft Failure - Older patients are at significant risk for developing interstitial fibrosis and tubular atrophy. These are the common histological abnormalities of kidney transplants in which an extended interstitial space replaces the normal cortical structures. This leads to a progressive decline in kidney transplant function.

How to Manage the Complications?

It is important to manage the complications of kidney transplantation, especially in the older population, as they are at greater risk for mortality. Some of the points are explained below-

1. Pre-Transplant Assessment - A detailed history of the recipient’s other medical conditions, history of other existing infections, and physiological status. It is also important to assess the patient’s essential vaccine list.

2. Diet - It is recommended to avoid unpasteurized dairy products and includes a well-maintained diet with enough water intake.

3. Infection Control - It is advised to avoid contaminated places or areas with heavy dust and maintain hygiene.

4. Post-Transplant - Proper rest and taking medications on time as advised by the doctor. It is important to visit the doctor for follow-ups as recommended by the doctor.

Conclusion

In conclusion, kidney transplantation is a viable treatment option for end-stage renal disease in older adults, as it can significantly improve their quality of life and increase their life expectancy. However, older adults are at a higher risk for complications following kidney transplantation, including cardiovascular events, infections, and organ rejection. Pre-transplant evaluation and careful selection of older adult candidates, along with close monitoring and management of post-transplant complications, are crucial for successful outcomes. Despite the potential risks, kidney transplantation remains a valuable and life-changing option for older adults with end-stage renal disease.