Risk Factors for Graft Failure and Death following Geriatric Renal Transplantation

Abstract

BackgroundPopulation aging is a major health concern in Asian countries and it has affected the age distribution of patients with end-stage renal disease (ESRD). As a consequence, the need for kidney transplantation in the geriatric population has increased, but the shortage of donors is an obstacle for geriatric renal transplantation. The aim of this study was to evaluate risk factors for graft failure and death in geriatric renal transplantation.MethodsKidney transplantations performed in a tertiary hospital in South Korea from May 1995 to December 2014 were retrospectively reviewed. Recipients younger than 60 years of age or who underwent other organ transplantations were excluded. The Kaplan-Meier method was used to assess patient and graft survival. A Cox regression analysis was used to evaluate risk factors for graft failure and patient death.ResultsA total of 229 kidney transplantation patients were included. Graft survival at 1, 5, and 10 years were 93.2%, 82.9%, and 61.2% respectively. Patient survival at 1, 5, and 10 years were 94.6%, 86.9%, and 68.8%, respectively. According to the Cox multivariate analysis, ABO incompatibility (hazard ratio [HR] 3.91, p < 0.002), DGF (HR 3.544, p < 0.004), CMV infection (HR 2.244, p < 0.011), and HBV infection (HR 6.349, p < 0.015) were independent risk factors for graft survival. Recipient age (HR 1.128, p < 0.024), ABO incompatibility (HR 3.014, p < 0.025), CMV infection (HR 2.532, p < 0.010), and the number of HLA mismatches (HR 1.425, p < 0.007) were independent risk factors for patient death.ConclusionKidney transplantation in the geriatric population showed good clinical outcomes. ABO incompatibility, DGF, CMV infection, and HBV infection were risk factors for graft failure and the recipient age, ABO incompatibility, CMV infection, and the number of HLA mismatches were risk factors for patient death in geriatric renal transplantation.

Risk factors for delayed graft function in deceased donor kidney transplantation; a potential preventive role for intraoperative thymoglobulin

“…Numerous factors in donors and recipients have been found to be associated with a greater risk of DGF development. In the recipients, male gender, older age, higher BMI, comorbid diabetes mellitus and longer pretransplant dialysis duration have been associated with DGF (6,(32)(33)(34). In the present study, we did not find any significant association between DGF and recipients' gender, age, BMI or pre-transplant dialysis duration.…”

What is the impact of human leukocyte antigen mismatching on graft survival and mortality in renal transplantation? A meta-analysis of 23 cohort studies involving 486,608 recipients

“…Detailed characteristics of included studies are presented in Table 1 . Among these studies, 18 studies provided multivariable-adjusted effect estimates [ 19 , 21 – 24 , 27 – 39 ], 3 studies provided both multivariable-adjusted and univariable-unadjusted data [ 20 , 25 , 26 ], and 2 studies provided univariable-unadjusted data [ 40 , 41 ]. Besides, 8 studies were multi-centered [ 19 , 23 , 27 , 32 , 33 , 35 , 37 , 38 ]; another 15 studies were single-centered [ 20 – 22 , 24 – 26 , 28 – 31 , 34 , 36 , 39 – 41 ].…”

Single-center analysis of infectious complications in older adults during the first year after kidney transplantation

“…While it is known that older adults have lower rejection rates after transplant[7,18,15] our rate (8%) is extremely low. Other groups have described rejection rates ranging from 11%−25% in patients with varying ages over 60[9,10,15,18,19]. The paradox of higher infection and lower rejection rates in the aged KT population calls to question whether the older cohort is over-immunosuppressed, a consequence of too much exogenous immunosuppression and immunosenescence.…”