Acute Rejection Profoundly Impacts Graft Survival in Young but Not in Old Kidney Transplant Recipients.
1Visceral, Transplantation and Thoracic Surgery, Medical University, Innsbruck, Austria
2Medical Statistics, Informatics and Health Economics, Medical University, Innsbruck, Austria
3General, Visceral and Transplantation Surgery, Charité
Universitätsmedizin, Campus Virchow, Berlin, Germany
4General, Visceral, Vascular and Thoracic Surgery, Charite Universitätsmedizin, Campus Mitte, Berlin, Germany.
Meeting: 2016 American Transplant Congress
Abstract number: A159
Keywords: Age factors, Elderly patients, Kidney transplantation, Rejection
Session Information
Date: Saturday, June 11, 2016
Session Name: Poster Session A: Kidney: Acute Cellular Rejection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Background: The proportion of marginal grafts and elderly recipients awaiting kidney transplantation is ever increasing. The correlation of age with DGF and acute rejection determines longterm graft outcome.
Methods: Data from patients >65years (n=193) and patients <65years (n=1054) transplanted between 2000 and 2010, were retrospectively analyzed regarding the age-dependent impact of delayed graft function (DGF) and biopsy-proven acute rejection (BxAR).
Results: Overall 10 year survival was lower in patients >65 years (p<0.0005) while death-censored graft survival was comparable to patients <65 years. DGF rates, HLA-MM and retransplantation rates were higher in elderly patients. However, patterns of acute rejection were significantly different in patients >65 years; Boderline and Banff Ia rejections were more frequent while more severe BxAR were significantly decreased. Ordinal regression analysis showed that the risk of BxAR declines with increasing age (p<0.0005).
First, risk factors influencing graft survival were analyzed: donor age, DGF and induction therapy were risk factors in both groups while BxAR was an additional factor in young patients. Consequently, BxAR significantly impaired graft survival in recipients <65years but not in older patients (p=0.055). Interestingly, this correlation was independent of the type of graft (ECD vs SCD) demonstrating a stronger effect of recipient age than donor age.
Next, age-dependent risk factors for BxAR were identified; DGF, anastomosis time (AT) and age were independently associated with BxAR in young patients while only DGF was a risk factor in old patients. Further analysis showed that DGF had a significant impact on BxAR in elderly recipients of ECD but not SCD grafts, underlining the importance of DGF in “old-for-old” transplantation.
Conclusion: Our study demonstrated a significant, age-dependent correlation of DGF and BxAR with graft survival. Reduction of DGF rates may help to decrease BxAR particularly in younger patients, thereby improving graft survival.
CITATION INFORMATION: Denecke C, Biebl M, Fritz J, Brandl A, Weiss S, Dziodzio T, Aigner F, Sucher R, Bösmüller C, Pratschke J, Öllinger R. Acute Rejection Profoundly Impacts Graft Survival in Young but Not in Old Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Denecke C, Biebl M, Fritz J, Brandl A, Weiss S, Dziodzio T, Aigner F, Sucher R, Bösmüller C, Pratschke J, Öllinger R. Acute Rejection Profoundly Impacts Graft Survival in Young but Not in Old Kidney Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/acute-rejection-profoundly-impacts-graft-survival-in-young-but-not-in-old-kidney-transplant-recipients/. Accessed July 5, 2020.« Back to 2016 American Transplant Congress