Background: Elderly patients are the fastest growing population requiring kidney transplantation internationally. Previous studies have shown a survival benefit for kidney transplantation when compared to dialysis in patients ≥70 years of age, at the expense of an increased risk of postoperative mortality. As our center has transplanted an increasing number of patients ≥80 years, close attention to this high risk population is warranted.

Methods: A retrospective review of renal transplant recipients ≥80 years was conducted under IRB approval. Kidney donor profile index (KDPI) and the estimated post-transplant survival (EPTS) scores were calculated for each donor and recipient. The primary outcome of interest was patient survival.

Results: 30 patients transplanted between 1999-2014 were identified. 26 (87%) were on dialysis prior to transplant. Hypertension (60%) and hypertension with diabetes (23%) were the cause of end-stage renal disease (ESRD) in the majority of patients. EPTS scores in this population were high (87-100%), conferring lower patient survival after transplant. Patient survival at 6 months, 1 year, and 3 years was 86.2%, 84.6%, and 66.7%, respectively. Median follow-up time post-transplant was 2 years (1 month to 8 years) when censored for early death in the post-operative period. At last follow-up, 24 patients (80%) had functional grafts. All patients received basiliximab induction. Maintenance therapy consisted of tacrolimus with a goal trough of 6-8 ng/mL, mycophenolic acid, and a steroid taper.

Conclusion: In carefully selected recipients, renal transplantation after the age of 80 remains a viable option. With the impending allocation system, some of the organs received by this cohort would have been allocated to recipients with greater expected survival. While implementation of a new allocation system is expected to impact donor quality and potentially graft function in this population, patient survival is not expected to be affected.

« Back to 2015 American Transplant Congress