Kidney Transplant Outcomes in Elderly Recipients: Age Alone Should Not Be a Barrier

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Journal of the American Society of Nephrology

Abstract

Background: Elderly(E) patients undergo fewer renal transplants due to concerns of increased mortality(M). We compared outcomes and risk factors for graft loss(GL) and M in our program’s E recipients to evaluate these concerns and inform decision-making.

Methods: Retrospective analysis of recipients from 1/13-6/22. Those aged 65 years(yrs) and older who received primary renal transplants were included. Recipients were grouped into younger(RY; 65-70yrs) and older(RO; 70+yrs). Baseline recipient and donor variables and transplant outcomes compared between groups. Primary outcomes of interest were patient survival(PS) and graft survival(GS). Kaplan-Meier(KM) survival analysis and multivariate Cox regression analysis(MA) performed on all variables with censoring date 11/26/23.

Results: 199 recipients included; 116 RY, 83 RO. RY had a significantly higher(p <  0.05) preop serum albumin(SA), shorter EPTS, and higher rates of hypertension, ischemic heart disease(IHD), and vascular disease. More RO had no induction agent(NA) and had a donor with diabetes(DM). Foley duration was longer and hydronephrosis rate higher in RY, while RO had higher rate of urine leak. Other characteristics and posttransplant complications did not differ significantly between groups. RY and RO had similar KM probabilities of 1-10 year GS(p=0.21-0.91) and PS(p=0.23-0.95). Median GS was similar between groups (8.5 vs 6.4 yrs, p=0.08), while PS was longer in RY (8.9 vs 7.2 yrs, p=0.05). On MA, higher 1-year serum creatinine was significantly associated with GL in both groups. Recipient DM, IHD, and DGF was associated with risk of GL and patient M for RY, while higher SA was associated with lower risk for both outcomes for RO. Induction with Simulect(vs.NA) associated with lower risk for patient M for RO(Figure 1).

Conclusion: Despite differences in baseline characteristics, we found comparable GS and PS between RY and RO groups, indicating that older age should not be a barrier to transplantation. Future analysis will include waitlisted and dialysis patients.

Volume

36

Issue

10S

Comments

Kidney Week 2025, American Society of Nephrology Meeting, November 5-9, 2025, Houston, TX

DOI

10.1681/ASN.2025q9tgdm2y

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