Factors Influencing Long-Term Patient and Allograft Outcomes in Elderly Kidney Transplant Recipients

Sarah So, Eric H.K. Au, Wai H. Lim, Vincent W.S. Lee, Germaine Wong

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Introduction: Individuals aged ≥65 years are increasingly prevalent on the waitlist for kidney transplantation, yet evidence on recipient and donor factors that define optimal outcomes in elderly patients after kidney transplantation is scarce. Methods: We used multivariable Cox regression modeling to determine the factors associated with all-cause death, death with a functioning graft, and overall and death-censored graft survival, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Results: A total of 802 kidney transplant recipients aged ≥65 years underwent their first transplantation between June 2006 and December 2016. Median age at transplantation was 68 years (interquartile range = 66−69 years). The 1-year and 5-year overall patient and graft survivals (95% confidence interval [CI]) were 95.1 (93.5−96.7) and 79.0 (75.1−82.9), and 92.9 (91.1−94.7) and 75.4 (71.3−79.5), respectively. Factors associated with higher risks of all-cause death included prevalent coronary artery disease (adjusted hazard ratio [95% confidence interval] = 1.47 [1.03–2.11]), cerebrovascular disease (1.99 [1.26–3.16]), increasing graft ischemic time (1.06 per hour [1.03–1.09]), donor age (1.02 per year [1.01–1.03]), delayed graft function (1.64 [1.13−2.39]), and peritoneal dialysis pretransplantation (1.71 [1.17–2.51]). Conclusion: Prevalent vascular disease and peritoneal dialysis as a pretransplantation dialysis modality are risk factors associated with poorer outcomes in transplant recipients aged ≥65 years. Careful selection and evaluation of potential candidates may improve graft and patient outcomes in older patients.

Original languageEnglish
Pages (from-to)727-736
Number of pages10
JournalKidney International Reports
Volume6
Issue number3
DOIs
Publication statusPublished - Mar 2021

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