Older kidney transplant recipients are vulnerable to early graft loss likely due to frailty and burden of comorbidities. Other factors not inherent to the recipient may also contribute to early graft loss. The goal of this study was to conduct a detailed assessment of risk factors for early graft loss in elderly kidney transplant recipients.

Methods: Retrospective longitudinal cohort study of 500 kidney transplant recipients age [sup3] 60, from 2005-2015. Detailed baseline demographic and transplant characteristics were abstracted from medical records. Univariate statistics and multivariable logistic modeling were used for analysis.

Results: 39 out of the 500 older kidney transplant recipients (7.8%) had graft loss within 1 year post-transplant. Demographic and clinical characteristics of the subjects are shown in Table 1. Univariate analysis showed that HTN as etiology of CKD (OR=2.0 [0.9-4.8]), longer dialysis duration (OR=1.2 [1-1.4]), previous transplant (OR=6.2 [1.6-23.4]), higher KDPI (OR=3.3 [1-13]), DGF (OR=3.8 [1.7-8.7]), and acute rejection (OR=3.2 [1.4-7.3]) were significantly associated with early graft loss in older kidney transplant recipients. Multivariate analysis showed that higher KDPI (OR=6.5 [1.2-33]), DGF (OR=4.3 [1.8-10.4]), GFR variability (OR=1.05 [1.03-1.08], PRA (OR=1.02 [1-1.03]) predicted early graft loss. On the other hand, female recipient gender (OR=0.14 [0.04-0.45]) was a protective factor. The same factors seem to predict graft loss within 2 years post-transplant. The final logistic model had excellent discernibility in predicting those at risk for early graft loss (AUC 0.833) (Fig. 1).

Conclusion: Several recipient and clinical characteristics significantly predict early graft loss in older kidney transplant recipients. Risk stratification of donors and recipients, judicious organ allocation, as well as close clinical monitoring of at-risk patients may help to preempt rapid GFR decline and early graft loss in older kidney transplant recipients. This study strongly suggests that a more rigorous selection and follow-up process especially for high risk older kidney transplant recipients may help improve graft outcomes in this group.

CITATION INFORMATION: Amaechi P., Rodriguez R., Rao V., Taber D., Posadas Salas M. Predictors of Early Graft Loss in Older Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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