S. A. Kelso2, J. A. Pineda1, M. C. Prikis3, C. E. Marroquin1 1University Of Vermont Medical Center,Division Of Transplant Surgery And Immunology,Burlington, VT, USA 2University Of Vermont,College Of Medicine,Burlington, VT, USA 3University Of Vermont Medical Center,Division Of Nephrology,Burlington, VT, USA
Introduction: Patients of all ages and causes of renal disease demonstrate survival benefit with kidney transplantation. This encouraged renal transplantation in elderly patients, traditionally thought to be over 60, that would previously have been maintained on lifelong dialysis. Organ systems including the immune and musculoskeletal systems naturally deteriorate as patients age. This natural senescence produces challenges in the elderly, which are compounded by immunosuppression, and consequently increases the potential for poor outcomes. In an effort to find the inflection point at which the benefits of transplantation are outweighed by the risks, this study analyzed rates of graft survival by recipient age and compared two separate elderly cohorts to younger recipients. We also evaluated the causes of graft failure in both young and elderly recipients.
Methods: Data from the United Network for Organ Sharing (UNOS) was used to identify primary renal transplant recipients between 1988 and 2014. The study period was divided into five eras, and the recipient population was divided into 13 age groups. Using the adjusted Scheffe Test of Significance, the graft survival of recipients from 65 to 69 and those over 70 years of age was compared to younger cohorts at 1, 3, 5, and 10 years post-transplantation. We also evaluated the causes of graft failure between these cohorts.
Results: A total of 192,233 primary renal transplants were performed between 1988 and 2014. In total, 17,476 (9.09%) of recipients were 65 to 69 and 10,930 (5.69%) were over age 70. A comparison of graft survival in patients between 65 to 69 years of age and those over 70 compared to the 25 to 64 age group demonstrated statistical significance (p-value <0.0001) at 1, 3, 5, and 10 years post-transplantation in all eras. Renal graft failure caused by infection and primary failure occurred at increasing rates in the elderly while failure due to hyperacute, acute, and chronic rejection and recurrent disease occurred at lower rates with progression of age and were more common in the younger cohort.
Conclusion:
Elderly renal transplant recipients have decreased renal graft survival compared to younger recipients across all eras. While this could be due to many confounders, our analysis suggests this is more an effect of age than immunosuppression regimens. Elderly recipients are at increased risk for graft loss due to primary failure and infection and lower risk of graft loss due to recurrent disease and episodes of rejection. This may have implications for clinical care in elderly renal transplant recipients to improve graft survival.
