J. Long1, K. Jackson1, J. Motter1, M. Waldram1, K. Covarrubias1, B. Orandi2, D. Segev1, J. Garonzik-Wang1 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA 2University Of Alabama at Birmingham,Birmingham, Alabama, USA
Introduction: Older individuals represent the fastest-growing population with end-stage renal disease (ESRD) in need of a kidney transplant. While incompatible living donor kidney transplantation (ILDKT) is known to provide survival benefit it is unknown if older individuals have similar post-ILDKT outcomes. Knowledge of the risk profile of older ILDKT recipients could help inform patient counseling and clinical management of this rapidly growing group of transplant recipients.
Methods: Using a 22-center ILDKT cohort linked to SRTR data, we compared post-transplant outcomes of 154 older (age >60) ILDKT recipients to 871 younger (age < 60) recipients. We analyzed mortality and death-censored graft failure using multivariable Cox regression. Delayed graft function (DGF) and length of stay (LOS) were evaluated using multivariable logistic regression and negative binomial regression, respectively. All models were adjusted for the following recipient and transplant characteristics: gender, body mass index, race, blood type, years on dialysis, panel reactive antibody, donor-specific antibody, and number of human leukocyte antigen mismatches.
Results: Compared to younger recipients, older recipients were more likely to be female (81.2% vs 64.5%, p<0.001), white (76.6% vs 64.5%, p=0.014), and to have been on dialysis prior to transplant (21.4% vs 10.8%, p<0.001). Older recipients were less likely to have had a prior transplant (16.2% vs 68.4%, p<0.001). The 1, 5, and 10-year post-transplant survival for older recipients were 92.2%, 81.1% and 50.0% compared to 95.5%, 86.6%, and 64.9% for younger recipients (p=0.02). The 1, 5, and 10-year death-censored graft survival were 96.6%, 84.6%, and 79.0% for older recipients compared to 93.6%, 76.0%, and 56.8% for younger recipients (p=0.005) (Table 1). In adjusted models, older recipients had a 60% increased risk of mortality (adjusted hazard ratio [aHR]: 1.101.602.34, p=0.01) and a 45% decreased risk of developing death-censored graft failure (HR: 0.360.550.86, p<0.01) compared to their younger counterparts. There were no differences in LOS (adjusted LOS ratio: 0.870.991.13, p=0.9) or DGF (adjusted odds ratio: 0.481.092.45, p=0.8).
Conclusion: While older ILDKT recipients have worse survival compared to younger recipients, their long-term survival is still good, and they have similar LOS and DGF. Older recipients should not be denied ILDKT based on age alone.
