BACKGROUND: Recent evidence suggests that, in general, kidney transplant (KT) outcomes are improving over time. However, this evidence is population-based, failing to evaluate trends in outcomes of various subgroups. Age limits for transplantation have expanded significantly, yet it remains unclear whether outcomes in older KT recipients have changed. The goals of this study were to identify mortality and graft loss trends for older KT recipients and compare them to those in younger KT recipients.
METHODS: We studied 278,941 KT recipients (30,207 aged ≥65) as reported to SRTR between 1990-2011. Mortality was obtained from Social Security Death Master File and graft loss through linkage with CMS. Relative mortality and death-censored graft loss by year of KT were estimated using adjusted Cox proportional hazards models.
RESULTS: Older adults currently represent 17.6% of KT recipients, a 5-fold rise from 3.2% in 1990. For older KT recipients, survival and death-censored graft survival improved over time among live donor and deceased donor recipients.
|Mortality||Death-Censored Graft Loss|
|Year of KT||Adjusted, Deceased Donor*||Adjusted, Live Donor**||Adjusted, Deceased Donor*||Adjusted, Live Donor**|
|1994-1996||0.89 (0.82-0.97)||1.04 (0.83-1.32)||0.85 (0.73-1.00)||1.07 (0.65-1.76)|
|1997-1999||0.82 (0.76-0.89)||1.04 (0.83-1.30)||0.86 (0.74-1.00)||0.85 (0.53-1.38)|
|2000-2002||0.77 (0.71-0.84)||0.88 (0.70-1.10)||0.77 (0.66-0.90)||0.79 (0.50-1.26)|
|2003-2005||0.65 (0.59-0.71)||0.71 (0.57-0.90)||0.65 (0.56-0.76)||0.76 (0.48-1.22)|
|2006-2008||0.56 (0.51-0.61)||0.60 (0.46-0.77)||0.58 (0.49-0.67)||0.55 (0.33-0.91)|
|2009-2011||0.43 (0.37-0.49)||0.52 (0.38-0.73)||0.43 (0.36-0.53)||0.48 (0.27-0.85)|
This improvement trend paralleled that of younger adults (interaction P=0.486 for patient survival and P=0.494 for graft survival).
CONCLUSION: Despite a major increase in number of older adults transplanted, patient and graft survival have improved over time, with the same magnitude as in younger adults. Appropriate older candidates should be encouraged to pursue KT, and information about improving outcomes needs to be disseminated to both patients and providers.
To cite this abstract in AMA style:McAdams-DeMarco M, James N, Walston J, Segev D. Trends in Kidney Transplant Outcomes in Older Adults [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/trends-in-kidney-transplant-outcomes-in-older-adults/. Accessed November 19, 2017.
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