Background: In older renal transplant recipients, where death with functioning graft limits life years gained, one of the primary purposes of transplant is to improve quality of life (QOL). The aim of this study was to determine if choice of induction therapy with its sequential effects on rejection, infection and readmissions, can impact QOL.

Methods: This was a sub-analysis of patients ≥50 years of age that participated in a single center, prospective, risk stratified, randomized, open label study of 200 KTX. Stratification occurred to ensure equal numbers of AAs, PRA >20% and CIT >24 hrs. Pediatric, HLA identical, non-KTX recipients, any positive cross-match and age >75 were excluded. All patients randomly received either rATG or IL-2RA in addition to FK, MMF, and corticosteroids. Outcome analysis includes safety, efficacy, and QOL. All results are reported at one year post-transplant.

Results: Of the 200 patients originally enrolled, 111 were at least 50 yo and included (48 received IL-2RA, 63 received rATG). Baseline characteristics were similar between groups. Aged patients that received rATG had a trend towards lower acute rejection rates, fewer readmissions, and fewer supratherapeutic tacrolimus troughs, with similar rates of infections. QOL analysis demonstrated aged patients that received rATG were significantly more likely to have improvements in physical and social functioning after transplant.

Conclusion: Contrary to the widely held belief to limit T-cell depletion in older recipients, patients ≥50 yo potentially benefit from rATG through lower acute rejections, readmissions to the hospital and minimizing tacrolimus exposure, leading to improvements in perceived physical and social functioning after transplant.

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