Long-term outcomes of graft function in elderly kidney transplant recipients
Bajjoka I, Yaldo A, Crombez C, and Abouljoud M. Long-term outcomes of graft function in elderly kidney transplant recipients. Am J Transplant 2018; 18:955-956.
Am J Transplant
Purpose: To compare and evaluate 5-year outcomes of graft function for younger (Y) versus elderly (E) kidney transplant recipients (KTR). Introduction: As the number of elderly KTR increases, differences between this population and younger are unknown. Methods: A single-center retrospective analysis of medical records of 318 firsttime KTR from 2003-10 on mycophenolate, tacrolimus, and steroid regimen was performed. The study population was divided into two cohorts: (Y: ≤59 yrs; n=172; E: ≥65 yrs; n=146). KTR aged 60-64 were excluded to distinguish groups. Baseline characteristics, first biopsy-proven acute rejection (BPAR), estimated glomerular fi ltration rates (eGFR) at discharge and annually up to 5 yrs were analyzed. BPAR were graded using Banff schema (≥2A = severe). Time to BPAR was demonstrated using Kaplan-Meier plots (KM) and reliability was tested using a multivariate Cox proportional-hazards model and log-rank test. Results: There was no statistical difference between demographics, induction therapy, maintenance immunotherapy, type of transplant, immediate graft function, BMI, length of stay, or median follow-up days [Y, 2132 (1770, 2729); E, 2048 (1540, 2538); p>0.05]. There was no difference in eGFR at yrs 0-5 (p>0.05). BPAR is described in table 1. KM exhibit less and earlier BPAR among E [0.376 (0.23, 0.615), p<0.001]. The log rank tests indicate time to BPAR are indeed different in Y and E (p<0.001). (Figure presented) (Table presented) Conclusions: Elderly KTR experience less rejection in incidence and severity. These patients also maintain excellent long-term graft function that is comparable to younger KTR.