Older kidney transplant recipients (KTR) face challenges of post-transplant complications related to frailty and comorbidities. They are particularly vulnerable to infectious complications. This study elucidates etiology of hospital admissions and outcomes in older KTR.

Methods: Ten-year, retrospective, longitudinal, cohort study of 500 patients age ≥ 60, who had kidney transplantation from 2005-2015. Demographic data, transplant characteristics, and outcomes data were collected. Manual chart abstraction and adjudication to determine primary etiologies for hospitalization were conducted. Standard univariate statistics and multivariable Cox regression modeling were utilized for analysis.

Results: Mean age of older KTR was 66 years (range 60-81). 59% were males and 50% were African Americans. 49% had CKD due to DM. 62% of older KTR had at least one hospitalization post-transplant. Significant predictors of hospitalization were DGF (HR=1.6 [CI 1.2-2.2]), DM (HR=1.3 [CI 1-1.7]), PRA (HR=1.3 [CI 1-1.7]), dialysis duration (HR=1.1 [CI 1-1.2]), p<0.05. Most common reasons for hospitalization were infection (95 admissions per 100 patient-yrs) and surgical complications (43 per 100 patient-yrs). Average length of stay was 6.4 days. Older KTR who had at least one hospitalization had 84% higher risk for graft loss (p=0.001) (Fig. 1), which varied substantially by hospitalization etiology. Specifically, hospitalizations due to rejection (HR=2.5 [CI 1.6-3.8]), opportunistic infections (HR=1.7 [CI 1.1-2.7]), or GI complications (HR=1.6 [CI 1.1-2.1]) were significant risk factors for graft loss, while those for other infections, cardiovascular events, diabetes, and AKI were not.

Conclusion: Post-transplant hospitalization in older KTR is highly prevalent and often due to infection. The primary readmission etiologies associated with graft loss are rejection, opportunistic infections, and GI complications. Hospitalization in older KTR has significant impact on graft survival. Addressing comorbidities and risks in the pre-transplant and outpatient setting may help alleviate burden of hospitalization in older KTR and significantly improve graft outcomes.

CITATION INFORMATION: Posadas Salas M., Rodriguez R., Amaechi P., Rao V., Taber D. The Etiologies and Impact of Hospitalization in Older Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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