Octogenarian Kidney Transplant Recipients: A Single Center Experience
University of Maryland Medical Center, Baltimore, MD.
Meeting: 2015 American Transplant Congress
Abstract number: A137
Keywords: Elderly patients, Kidney transplantation, Survival
Session Information
Session Name: Poster Session A: Kidney Candidate Issues and Outcomes
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Elderly patients are the fastest growing population requiring kidney transplantation internationally. Previous studies have shown a survival benefit for kidney transplantation when compared to dialysis in patients ≥70 years of age, at the expense of an increased risk of postoperative mortality. As our center has transplanted an increasing number of patients ≥80 years, close attention to this high risk population is warranted.
Methods: A retrospective review of renal transplant recipients ≥80 years was conducted under IRB approval. Kidney donor profile index (KDPI) and the estimated post-transplant survival (EPTS) scores were calculated for each donor and recipient. The primary outcome of interest was patient survival.
Results: 30 patients transplanted between 1999-2014 were identified. 26 (87%) were on dialysis prior to transplant. Hypertension (60%) and hypertension with diabetes (23%) were the cause of end-stage renal disease (ESRD) in the majority of patients. EPTS scores in this population were high (87-100%), conferring lower patient survival after transplant. Patient survival at 6 months, 1 year, and 3 years was 86.2%, 84.6%, and 66.7%, respectively. Median follow-up time post-transplant was 2 years (1 month to 8 years) when censored for early death in the post-operative period. At last follow-up, 24 patients (80%) had functional grafts. All patients received basiliximab induction. Maintenance therapy consisted of tacrolimus with a goal trough of 6-8 ng/mL, mycophenolic acid, and a steroid taper.
Parameter | Result | |
---|---|---|
Age at Transplant (years), mean±SD | 83±2 | |
Male, n (%) | 26 (87) | |
Race, n (%) | ||
Caucasian | 25 (83) | |
African American | 2 (7) | |
Other | 3 (10) | |
ESRD Cause, n (%) | ||
Hypertension | 18 (60) | |
Hypertension+Diabetes | 7 (23) | |
Other | 5 (17) | |
Time on Dialysis Pre-Transplant (years), mean±SD | 3.5±2.9 | |
Transplant Type, n (%) | ||
Living Donor | 3 (10) | |
SCD | 10 (33) | |
ECD | 12 (40) | |
DCD | 2 (7) | |
Cold Ischemic Time (hours), mean±SD | 23±12 | |
KDPI Score (%), mean±SD | 66±29 | |
EPTS Score (%), mean±SD | 96±9 |
Conclusion: In carefully selected recipients, renal transplantation after the age of 80 remains a viable option. With the impending allocation system, some of the organs received by this cohort would have been allocated to recipients with greater expected survival. While implementation of a new allocation system is expected to impact donor quality and potentially graft function in this population, patient survival is not expected to be affected.
To cite this abstract in AMA style:
Ravichandran B, Sparkes T, Thomas B, Rasetto F, Gillespie M, Moss M, Bartlett S, Masters B. Octogenarian Kidney Transplant Recipients: A Single Center Experience [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/octogenarian-kidney-transplant-recipients-a-single-center-experience/. Accessed October 9, 2024.« Back to 2015 American Transplant Congress