Background: Patients with established renal failure (ERF) are aging. Of patients starting dialysis at our centre a third and a half are over the age of 70 and 65 years respectively, with a total dialysis population of 1500 patients. Age is not contraindication to transplantation but age related co-morbidity is an important limiting factor. Mortality rates in dialysis populations are declining and comparative published data regarding the outcome of transplantation in the elderly are historic. The aim of this study was to benchmark the survival advantage of transplantation in the elderly in a modern era.

Methods: A single centre prospective cohort of patients above the age of 65 was studied with a protocolised tacrolimus-based steroid avoidance treatment from the time of activation on the wait-list 01 November 2005 till 31 March 2015.

Results: 354 patients (70.4% male) were medically fit to be activated on the transplant waiting list. One third of those patients (34.5%) received a transplant while the rest continued with dialysis, median (IQR) follow up time 4.0 (1.9/6.1) years. The transplant recipients were younger, median age (IQR) in years 67.7 (66.2/69.7) vs 69.5 (66.8/72.6) (p=0.001) and started dialysis at a younger age 66.4 (64.5/69.1) vs 68.2 (65.3/71.7) (p=0.004). Ethic case-mix was comparable in both groups(38.8% Caucasian, 31.5% South-Asian, 16.8% Afro-Caribbean transplanted vs 45.1%, 32.8%, 17.2% wait-listed respectively) and both groups had similar comorbidities. A multivariate time-dependent Cox regression analysis, adjusted for age, ethnicity, gender, time on waiting list, diabetes (DM), dialysis vintage, modality type and duration, revealed a positive effect of transplantation (HR:0.56 – 95%CI 0.31 to 0.94, p=0.04) on survival. DM (HR:1.83 – 95%CI 1.13 to 2.9, p=0.011) and dialysis vintage in years: (HR:1.14, 95%CI 1.04 to 1.125, p=0.01) were significant risk factors for mortality. Excluding pre-emptive, live-donor transplantation, the survival advantage still remains evident.

Conclusion: In our multi-ethnic cohort of patients transplantation in the above 65 year-old should be considered as it offers a significant survival advantage while comorbidities and frailty is likely influential with increased age.

CITATION INFORMATION: Spanos G, Duncan N, Brookes P, Goodall D, Koutroutsos K, Evangelou E, Loucaidou M. Survival Advantage in the Elderly with Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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