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Infectious Complications and Malignancy after Kidney Transplantation in the Elderly Population

L. Liriano-Ward, M. Parides, Y. Al Azzi, C. Pynadath, M. Ajaimy, J. Graham, S. Greenstein, M. Kinkhabwala, J. Rocca, E. Akalin

Montefiore Medical Center, Bronx, NY

Meeting: 2020 American Transplant Congress

Abstract number: 273

Keywords: Infection, Kidney transplantation, Malignancy

Session Information

Session Name: Kidney Infections Excluding Polyoma & Viral Hepatitis

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 3:39pm-3:51pm

Location: Virtual

*Purpose: Kidney transplantation improves quality of life and survival in all patients regardless of age. However, older patients are prone to development of side effects related to immunosuppressive medications including infections and malignancy. We aim to evaluate clinical outcomes in recipients older than 65 years of age.

*Methods: We retrospectively reviewed all patients over the age of 18 who received an isolated renal transplant at our center from January 2013 to June 2017. We compared clinical outcomes including allograft and patient survival, as well as the development of infections (opportunistic and non-opportunistic) malignancy in patients older than 65 compared to younger patients.

*Results: Of the 624 patients analyzed, 148 (24%) were older than 65 years of age. There was no difference in terms of gender, race, immunosuppressive or induction therapy between the two groups. Older patients were more likely to receive a deceased donor kidney transplant (92% vs. 81%, p=0.009). During a median 48 months (28, 70) of follow-up, as expected mortality was higher in older patients (16% vs. 6.5%, p=0.0001) but there was no difference in terms of death-censored graft loss (10.8% to 9%, p=0.52) compared to younger patients. Detailed analysis of infections revealed that there was no difference in terms of BKV and CMV viremia, pneumonia, bacteremia, influenza and c. diff between the two groups. However, older patients had more fungal and urinary tract infections and malignancy. The most common infection in the elderly was PJP pneumonia occurring in 4%, followed by candidemia 3%, and cryptococcal infection 2%. The most common malignancy in the elderly was skin cancer, occurring in 6% of patients, followed by prostate 2%, lung 1%, and colon 1%.

*Conclusions: Recipients older than 65 had similar graft survival compared to younger patients, but had a higher incidence of fungal and urinary tract infections and malignancies.

Clinical Outcomes Post-Kidney Transplant
Clinical Outcomes Patients with age > 65 years old Patients with age =< 65 years old p-value
BKV 22% 19% 0.43
CMV 12% 9% 0.25
Pneumonia 23.7% 20% 0.38
Bacteremia 20% 18% 0.55
Urinary tract infections 49% 31% <0.0001
Fungal infections 10.5% 5.1% 0.02
Malignancy 16% 5% <0.0001

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To cite this abstract in AMA style:

Liriano-Ward L, Parides M, Azzi YAl, Pynadath C, Ajaimy M, Graham J, Greenstein S, Kinkhabwala M, Rocca J, Akalin E. Infectious Complications and Malignancy after Kidney Transplantation in the Elderly Population [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/infectious-complications-and-malignancy-after-kidney-transplantation-in-the-elderly-population/. Accessed May 10, 2025.

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