Elderly Kidney Transplant Recipients Need Optimized Immunosuppression According to Comorbidity and Infection.

E. Kang,¹ S. Park,¹ S. Park,¹ S. Yang,² I. Jung,³ S.-K. Park,⁴ Y. Kim,⁵ D.-J. Han,¹ Y. Kim,¹ J. Lee.⁶

¹Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
²Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
³Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
⁴Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
⁵Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
⁶Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.

Meeting: 2016 American Transplant Congress

Abstract number: B130

Keywords: Elderly patients, Immunosuppression, Kidney transplantation

Session Information

Session Name: Poster Session B: Drug Minimization

Session Type: Poster Session

Date: Sunday, June 12, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Backgrounds: The numbers of elderly kidney transplantation is increasing, but there are limited studies about the use of immunosuppressant in this group. We investigated the usage, drug levels of immunosuppressant and the outcomes in the elderly compared with younger recipients.

Methods: Data from elderly(>60yrs, n=177) and younger(≤60yrs, n=2939) recipients from 3centers between 1997 and 2012 were recruited. The type and levels of immunosuppressant were compared according to the age. Patient and graft survival, biopsy-proven acute rejection(BPAR), infection requiring hospitalization, and malignancy were analyzed according to the immunosuppressant usage in the elderly.

Results: Chalson's comorbidity score(CCI) in elderly was higher than in younger(2.6±1.1 vs. 3.6±1.4, p<0.001). In the elderly, the rates of infection, malignancy, graft failure and mortality were higher(p<0.001). Between younger and elderly groups, time-averaged trough levels were similar at 1month and at 1year post-transplant. However, trough levels for 1year were lower in the elderly than younger recipients(7.2±1.9 vs. 7.9±1.9ng/mL for tacrolimus[Tac], p=0.001; 192.0±121.2 vs. 239.1±151.0ng/mL for cyclosporine[CsA], p=0.028). The elderly with higher CCI(score 5-7) more rapidly tapered CsA than those with lower CCI(score 2-4) (trough level for CsA: 204.7±130.7 vs. 139.9±44.0ng/mL, p=0.012), but not Tac(7.3±1.6 vs. 7.0±1.6ng/mL, p=0.287). Elderly patients with infection after transplantation tapered immunosuppression rapidly. There were no significant differences of BPAR, graft failure, malignancy and mortality rates between rapid and slow tapering groups.

Conclusions: The elderly used lower dose of immunosuppressant than the younger due to higher comorbidities, infection rate and mortality. Elderly patients with post-transplant infection and many comorbidities need earlier tapering of immunosuppression.

CITATION INFORMATION: Kang E, Park S, Park S, Yang S, Jung I, Park S.-K, Kim Y, Han D.-J, Kim Y, Lee J. Elderly Kidney Transplant Recipients Need Optimized Immunosuppression According to Comorbidity and Infection. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Kang E, Park S, Park S, Yang S, Jung I, Park S-K, Kim Y, Han D-J, Kim Y, Lee J. Elderly Kidney Transplant Recipients Need Optimized Immunosuppression According to Comorbidity and Infection. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/elderly-kidney-transplant-recipients-need-optimized-immunosuppression-according-to-comorbidity-and-infection/. Accessed November 22, 2024.

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