Introduction:

Elderly patients with chronic kidney disease are nowadays more often considered for kidney transplantation although death rate is increased in this population compared to younger recipients. Risk factors of mortality are therefore needed in this elderly population of kidney transplant recipients.

Material and Methods:

We retrospectively studied all kidney transplantations performed in patients over 65 years old at our institution between 01/01/2005 and 31/12/2012. Both clinical characteristics of recipients the day of transplantation and potential biomarkers such as Albumin, Troponin and C-reactive were studied. We tested in univariate and multivariate analysis factors associated with the risk of death, using the Kaplan-Meier and the Cox Proportional Hazards method.

Results:

Out of 212 patients (mean age: 69 ± 4 years, 62 % male), 201 had a troponin dosage available at day 0, which was elevated (> 0.04 ng / ml) in 35 patients (17.4 %). With regard to comorbidities, 22.5% of patients had ischemic heart disease, and 27.5% had type 2 diabetes. Patient survival was 87.8% at 1 year, 77.8% at 3 years and 61% at 5 years. The most common causes of mortality were infections (44.0 %) and cardiovascular diseases (31.6 %). In univariate analysis, troponin at transplantation as a qualitative covariable was associated with a significantly lower patient survival (log rank test, p=0.0005). In multivariate analysis, factors independently associated with mortality were donor body weight (HR 1.032, 95% CI 1.015-1.050), recipient body weight (HR 0.967 95% CI 0.947-0.988), Charlson Comorbidity Index (HR 1.31 95% CI 1.077-1.593) and the level of troponin (HR 5.34 95% CI 1.245-22.921).

Conclusion:

Elevated troponin the day of kidney transplantation is associated with a lower patient survival in elderly patients.

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