Understanding Trends and Predictors of Outcome in Elderly Renal Transplant Recipients: An Analysis of the UNOS Registry.
Dieplinger G, Everly MJ.
Clinical Transplants 2013, Chapter 1
The continuously growing number of patients of advanced age with end-stage renal disease demands adequate treatment in the form of renal transplantation. Despite the benefits of transplantation in elderly recipients, the mortality risk remains clearly higher compared to younger recipients. This report aims to give an actual overview of outcomes in deceased donor transplantation of advanced age recipients, by comparing graft and patient survival of transplants recorded in the United Network for Organ Sharing registry from 2000 to 2012, between three age groups: 70-84, 50-69, and 35-49 years of age. Subsequently, risk factors for graft failure and death were analyzed for elderly (70-84 years) recipients and their mortality compared to young (35-49 years) recipients. Elderly recipients showed higher death-censored graft survival and lower patient survival (log-rank p<0.001). Graft failure was highly associated with expanded criteria donors and delayed graft function (DGF) (<0.001). The strongest risk factors for death were peripheral vascular disease, DGF, and previous allograft failure (p<0.001). The overall relative risk of death was more than four times higher for elderly than for young recipients (hazard ratio, 4.36; confidence interval, 4.13-4.59; p<0.001). Furthermore, the impact of previously identified, pre-transplant risk factors for death among elderly recipients and young recipients was analyzed and differed clearly between the subgroups. This report investigated risk factors and outcomes in elderly recipients similar to previous reports, but in a more recent transplant population, up to 2012. While mortality is elevated in elderly recipients, differences for subgroups defined by pre-transplant risk factors can help to better compare the risk between elderly and younger recipients.