C. E. Haugen1, Q. Huang1, M. McAdams-DeMarco1,2, D. L. Segev1,2 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA 2Johns Hopkins Bloomberg School Of Public Health,Epidemiology,Baltimore, MD, USA
Introduction: Outcomes in solid organ transplantation (SOT: heart, lung, liver) have improved, and SOT recipients are living longer with functioning grafts. However, between 7-21% of SOT recipients will develop end-stage renal disease secondary to calcineurin inhibitor immunosuppression and a growing number of SOT recipients will be listed for and undergo kidney transplantation (KT). Similar KT graft survival yet worse overall survival has been reported in adult prior SOT recipients, but it is unclear if these outcomes are similar among older (age≥65) prior SOT recipients who undergo KT. In light of the aging SOT recipient population, KT outcomes should be evaluated, given the higher prevalence of comorbidities and frailty in older adults.
Methods: 40,730 older (age≥65) KT recipients were identified using the US Scientific Registry of Transplant Recipients (1/1/1990-12/31/2015). Adjusted Cox proportional hazards models were used to estimate differences in graft and patient survival after KT between prior SOT and no prior SOT recipients.
Results: Since 1990, 948 prior SOT recipients (485 liver, 396 heart, 67 lung) have undergone KT after age 65. The number of older KT recipients with prior SOTs has increased annually since 1990 with a range of 0-74 performed per year. Prior SOT recipients were more likely to male, Caucasian, have renal failure from calcineurin inhibitors, undergo a pre-emptive KT, and receive a living donor than no prior SOT recipients. Five-year death-censored graft loss was 88% for recipients with prior SOT and 88% with no prior SOT; the corresponding five-year mortality was 71% and 64% (Figure). After adjustment, death-censored graft loss (aHR:1.25, 95%CI:1.01-1.54, p=0.04) and mortality (aHR: 1.43, 95%CI:1.28-1.59, p<0.001) were greater for older prior SOT recipients than no prior SOT recipients. Regardless of prior SOT type, mortality for older prior SOT recipients was greater compared to no prior SOT recipients (lung- aHR: 4.06, 95%CI:2.35-7.00, heart- aHR: 1.35, 95%CI:1.16-1.58, and liver- aHR: 1.41, 95%CI:1.22-1.65).
Conclusions: Older KT recipients of prior SOT have worse KT graft and overall survival compared to no prior SOT recipients. Appropriate and careful selection of older KT recipients is imperative in this population of SOT recipients given worse outcomes.
