Young adults have worse kidney transplant outcomes than other age groups

Abstract

Background The objective of this study was to establish if renal transplant outcomes (graft and patient survival) for young adults in England were worse than for other age groups. Methods Outcomes for all renal transplant recipients in England (n = 26 874) were collected from Hospital Episode Statistics and the Office for National Statistics databases over 12 years. Graft and patient outcomes, follow-up and admissions were studied for all patients, stratified by age bands. Results Young adults (14–23 years) had substantially greater likelihood [hazard ratio (HR) = 1.26, 95% confidence interval (CI) 1.10–1.19; P < 0.001] of kidney transplant failure than any other age band. They had a higher non-attendance rate for clinic appointments (1.6 versus 1.2/year; P < 0.001) and more emergency admissions post-transplantation (25% of young adults on average are admitted each year, compared with 15–20% of 34- to 43-year olds). Taking into account deprivation, ethnicity, transplant type and transplant centre, in the 14- to 23-year group, return to dialysis remained significantly worse than all other age bands (HR = 1.41, 95% CI 1.26–1.57). For the whole cohort, increasing deprivation related to poorer outcomes and black ethnicity was associated with poorer outcomes. However, neither ethnicity nor deprivation was over-represented in the young adult cohort. Conclusions Young adults who receive a kidney transplant have a significant increased likelihood of a return to dialysis in the first 10 years post-transplant when compared with those aged 34–43 years in multivariable analysis.

Kidney-transplanted Adolescents—Nonadherence and Graft Outcomes During the Transition Phase: A Nationwide Analysis, 2000–2020

“…In concordance with other studies, we found that adolescents and young adults have worse graft outcomes than other age groups, 11 , 29 verified by the 5-y survival rate that was significantly lower in the youngest group (<26-y; 89% versus 26–50 y; 94% [ P = 0.01]). Another study has also found the time period around the transition to adult-oriented care to be a high-risk period.…”

“…34 Hooper et al implemented an adherence promotion system at their center in which they approached the patients' barriers to medication adherence in conjunction with a designated clinical team and demonstrated a 50% reduction of allograft acute rejection. 35 In concordance with other studies, we found that adolescents and young adults have worse graft outcomes than other age groups, 11,29 verified by the 5-y survival rate that was significantly lower in the youngest group (<26-y; 89% versus 26-50 y; 94% [P = 0.01]). Another study has also found the time period around the transition to adult-oriented care to be a high-risk period.…”

Personalized Prediction of Kidney Function Decline and Network Analysis of the Risk Factors after Kidney Transplantation Using Nationwide Cohort Data

“…A recipient age ≥ 60 years is a risk factor for one-year eGFR decline, and affects the five-year eGFR by lowering one-year eGFR [ 10 ]. In addition, previous studies have demonstrated that renal allograft survival is the worst in young recipients between 10 and 20 years of age [ 33 , 34 ]. It should also be noted that the proposed network showed that the recipient age < 29 years was associated with high eGFR at discharge, whereas the recipient age > 57 years was related to low eGFR at discharge ( Figure 4 ).…”

Calcineurin inhibitors and related medicines: a cohort study examining England’s primary care prescription changes during the COVID-19 pandemic (January 2019 to March 2021)

“…Care within ethnic minority groups [10] can be difficult with patients being on the waiting list [11] for longer periods of time due to a shortage of organs from suitably appropriate ethnic minority donors, there may be other barriers such as language, cultural or misunderstanding of service [12] care pathways [13]. Some evidence suggests that young adults may have worse outcomes [14]. Many UK transplant centres currently provide restricted access due to COVID-19 [15].…”