Introduction Cancer is a growing cause of morbidity and mortality after kidney transplantation, driven by immunosuppression. Age is one of the strongest risk factors for developing cancer after transplantation and considering immunosenescence in the elderly, age-adapted immunosuppression may be warranted for older adults to reduce overall immunosuppression burden.

Methods Data was extracted by the hospital informatics team for all kidney allograft recipients transplanted at our centre between 2007 and 2015. Electronic patient records were then manually searched to facilitate data linkage to create a comprehensive database of baseline demographics, donor details, biochemical parameters, histology and clinical events.

Results Data was extracted for 1,140 kidney allograft recipients, with median follow up 4.4 years post-transplantation. Median age was 47 and we classified older as aged 47 and over compared to younger recipients aged under 47. Older versus younger recipients had increased risk for death post-transplantation (10.6% versus 3.3%, p<0.001) but not death-censored graft loss (9.1% versus 11.3%, p=0.130). Cancer-related mortality for older versus younger recipients was 12.9% versus 5.9%. Cancer was more common in older versus younger recipients (9.0% versus 3.1%, p<0.001) for skin cancer (3.0% versus 0.9%) and non-skin cancers (6.1% versus 2.2%). Older versus younger recipients were more likely to have cardiac events (9.6% versus 2.2%, p<0.001) and cerebrovascular events (3.2% versus 1.5%, p=0.039) post-transplant. However, older versus younger recipients had the same risk for cellular rejection (13.7% versus 12.6%, p=0.324) but reduced risk for antibody-mediated rejection (2.7% versus 4.7%, p=0.047) or mixed rejection (1.4% versus 3.5%, p=0.015). Older recipients were more likely to receive their first kidney allograft, confounding rejection risk.

Conclusion Older kidney allograft recipients have increased risk for death and immunosuppression-related complications including cancer, cardiac and cerebrovascular events but reduced risk for rejection. Our data supports the rationale of older recipients may benefit from tailored immunosuppression to reduce risk from immunosuppression-related complications but targeted clinical trials in the older adult population are warranted.

CITATION INFORMATION: Jackson-Spence F, Gillott H, Tahir S, Evison F, Nath J, Sharif A. Age Adapted Immunosuppression for Elderly Kidney Allograft Recipients: Balancing Risks for Cancer versus Rejection. Am J Transplant. 2016;16 (suppl 3).

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