Patients over 65 made up 17.5% of all incident transplant recipients in the US in 2011. Although transplantation confers a long-term survival benefit compared to dialysis, elderly patients have a higher risk of death in the early post-transplant period. Therefore, defining risk factors for death in the early post-transplant period is important.

Since elderly recipients are more likely to receive an ECD kidney which may confer a higher risk of delayed graft function (DGF), we sought to examine the impact of DGF on early post-transplant survival as a function of recipient age.

Methods: Using data from the USRDS, we utilized Cox PH models to examine the association of DGF with death within the first 6 months post-transplant in deceased donor kidney transplant recipients aged 18-39 (n=17,366), 40-49 (n=18,047), 50-59 (n=21,333), 60-69 (n=15,333), and 70+ years (n=4308) during 1997-2007.

Results: The incidence of DGF was similar in all age groups, ranging from 20-23%. The table outlines the hazards for death in the first 6 months post-transplant in those with DGF compared to those without DGF in each age group, adjusted for donor, recipient, and transplant factors. DGF was associated with a higher hazard of death within the first 6 months in recipients aged 70 and older, whereas this was not seen in other age groups.

Conclusions: DGF is associated with a higher risk of death in the early post transplant period in elderly kidney transplant recipients. Efforts to minimize DGF are paramount in the management of elderly transplant patients, including counseling of elderly candidates to consider living donor transplantation.

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