Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Introduction: The number of patients aged 70 years and older receiving renal replacement therapy is increasing. There is uncertainty regarding whether listing for deceased donor kidney-only transplantation (DDKTx) is appropriate in this age group, and if outcomes post-transplant are acceptable.
Methods: UK transplant registry data from 2005 – 2013 were analysed, with end of follow-up till 2016. Outcomes of patients aged 70 and more at listing for DDKTx were compared with those aged 60-69 at listing. Post-transplant outcomes were compared in those aged ≥70 years at time of transplantation with those aged 60-69 years. Kaplan Meier method was used to compare survival between groups and hazard ratios of covariates in Cox regression survival analysis were calculated.
Results: During the study period 4739 patients aged ≥60 years were listed for DDKTx; 20.3% (960) were ≥70 years old. By 2016, 42.1% of the older cohort had been transplanted but 50.3% had been removed or died on the list. Over the same period, 3261 patients aged ≥60 years underwent DDKTx; 727 of them (22%) were aged ≥70 years. Elderly recipients were more likely to receive a kidney from an older donor (median (IQR) age 62 (53-69) vs 58 (49-66) years; p<0.001), a dual transplant (7.2% vs 4.1%; p<0.001) and a kidney with higher KDRI (1.46±0.4 vs. 1.38±0.4; p<0.001). There were no statistically significant differences in proportions of DCD donors, graft CIT, recipient ethnicity, or cRF between the two groups. Graft outcomes were similar, with no significant differences in rates of PNF (2.9% vs 3%), rejection within 3 months (9.1% vs 7.9%), or death-censored graft survival up to 10 years. eGFR of functioning grafts 1, 3, and 5 years after transplant was not statistically significant different between groups. Patient survival was worse in the elderly group (p<0.001) and more had died with a functioning graft by the end of follow-up (20.6% vs 15.2%; p<0.01).
Discussion: More than half of elderly patients listed for DDKTx are removed or die on the list. Elderly recipients have similar graft function and death-censored graft survival post-transplant to those aged 60-69 years at transplantation. Patient survival is worse, however, and a high proportion die with a functioning graft. National organ allocation scheme should be altered to enable better matching of graft survival and recipient life expectancy.
CITATION INFORMATION: Adamusiak A, Salter T, Andrews P, Callaghan C. Outcomes of Deceased Donor Kidney Transplantation in Elderly Recipients Aged 70 Years and Older. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Adamusiak A, Salter T, Andrews P, Callaghan C. Outcomes of Deceased Donor Kidney Transplantation in Elderly Recipients Aged 70 Years and Older. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-deceased-donor-kidney-transplantation-in-elderly-recipients-aged-70-years-and-older/. Accessed January 24, 2020.
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