Background: Kidney transplantation is increasingly being offered to the very elderly (Age>70 years) kidney transplant recipients. Previous studies analyzing the effect of induction immunosuppression in patients aged above 60 years have shown that T-cell depletional agents are associated with a reduced risk of acute rejection with equivalent graft and patient survivals. Other studies have raised concern that these agents are associated with an increased risk of infections. No similar data exists for the very elderly who might be further at risk for infections due to immunosenescence. In this study we examined the impact of T-cell depletion induction on graft and patient outcomes in the very elderly.

Methods: We queried the OPTN (Organ Procurement and Transplant Network) data registry for all kidney-only transplant recipients aged>70 years from 2000 to 2013 to allow for the potential of >=12 months post-transplant follow-up. We analyzed patients who received either: no antibody induction or basiliximab/daclizumab (Non-T-cell dep) vs. those who received alemtuzumab or anti-thymocyte globulin (T-cell dep). Kaplan-Meier estimates of the survival function as well as Cox proportional hazards models were utilized.

Results: Among 10,945 patients aged>70 yrs with kidney transplants, 5061 (46%) patients were induced with T-cell dep, while 5931 (54%) patients received non-T-cell dep. Kaplan Meier survival analysis demonstrated no significant difference between the two groups in terms of 5-year death-censored graft survival (p=0.07), although patient survival was stastically but not clinically superior (p=0.04). Patients who received T-cell dep were more likely to be 'high immunologic risk' with greater HLA mismatches, re-grafts, higher kidney donor risk index (KDRI), and prolonged cold ischemia time. T-cell dep was associated with a decreased risk of acute rejection in the first year post-transplant (p=0.001). In adjusted Cox regression models, induction with T-cell dep was associated with a decreased risk of allograft loss with a hazard ratio (HR) of 0.87 (95% CI: 0.757–0.996; p=0.04) with a non-significant association with patient survival.

Conclusions: Induction with T-cell depletion seems to be safe and efficacious in the very elderly. Further subgroup analysis needs to be performed to target specific induction protocols to specific sub-populations.

CITATION INFORMATION: Dave H, Wolfe L, Fattah H, Kumar D, King A, Levy M, Cotterell A, Sharma A, Bhati C, Gupta G. Induction with T-cell Depletional Agents Is Safe and Efficacious in the Very Elderly Kidney Transplant Recipients: An Analysis of the OPTN Database. Am J Transplant. 2016;16 (suppl 3).

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