Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: We hypothesize that careful patient selection and waitlist management minimizes the impact of advanced recipient age on kidney transplant outcomes.
*Methods: A total of 3,521 patients were referred to our transplant institute between 2013-2018. We were able to evaluate 3,471 patients. We divided patients into 3 age groups(years): Group 1: 19-59 years (n=1903), Group 2: 61-69 years (n=1134) and Group 3: ≥ 70 years (n=484). Frist, we compared the likelihood of being evaluated, waitlisted, transplanted amongst the 3 age groups. Next patient outcomes including DGF, death from the time of referral and graft survival were analyzed after adjusting for time on waitlist using a multivariate Cox proportional hazards model.
*Results: In our center, all patients in group 3 are reviewed and seen, at minimum, once a year by transplant nephrology to maintain their waitlisted status.
The odds of likelihood to be evaluated for transplantation was significantly higher in group-3 when compared to either group-1 (OR, 2.02, 95% CI 1.6-2.5, p<0.001) or group-2 (OR, 1.55, 95% CI 1.25-1.9, p<0.001). Despite this, patients in group-3 were significantly less likely to be waitlisted, either when compared to group-1 (OR, 1.55, 95% CI 1.26-1.9, p<0.05) or group-2 (OR, 1.9, 95% CI 1.5-2.3, p<0.001). Similarly these patients were again significantly at lower odds to be transplanted (group 1 vs. group-3, OR 9.5, 95% CI 6.5-13.8, p<0.001; group 2 vs. group-3, OR 1.5, 95% CI 1.1-2.2, p<0.001). Thus, while older patients were readily evaluated, they were less likely to be wait-listed or transplanted.
Next, patients in group-3 had comparable survival to group-2, from the time of wait listing (HR, 0.96, p=NS). Although group-1 had better survival, this barely reached statistical significance (HR, 0.51, 95% CI 0.26-1.0, p=0.05). Again, graft survival was comparable in group-2 and group-3 (HR, 1.1, p=Ns), while group-1 had 0.47 hazard of death censored graft loss, this was not statistically significant (p= 0.11).
*Conclusions: An increasing number of elderly patients (≥ 70 years) and increased organ demand coupled with limited organ availability continues to pose problems in organ allocation and utilization. Despite the less likelihood of being on the waitlist or being transplanted, elderly patients in our study had comparable survival and graft outcomes to those who were younger, thus highlighting the value of transplantation in this cohort of patients. Careful selection and wait-list management practices could help improve transplant rates in this population.
To cite this abstract in AMA style:Munjal RS, Kalra K, Cherukuri A, Jorgensen D, Verma S, Sood P, Mehta R, Puttarajappa C, Hariharan S, Wu C. Managing the Road to Kidney Transplantation in the Elderly [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/managing-the-road-to-kidney-transplantation-in-the-elderly/. Accessed November 29, 2020.
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