Characterizing the risk of HLA-incompatible living donor kidney transplantation in older recipients.

Overview

Older compatible living donor kidney transplant recipients (CLDKT) have higher mortality and death-censored graft failure compared to younger recipients. These risks may be amplified in older incompatible living donor kidney transplant recipients (ILDKT) who undergo desensitization and intense immunosuppression. In a 25-center cohort of ILDKT recipients transplanted between September 24, 1997 and December 15, 2016, we compared mortality, death-censored graft failure (DCGF), delayed graft function (DGF), acute rejection (AR), and length of stay (LOS) between 234 older (age≥60) and 1172 younger (age 18-59) recipients. To investigate whether the impact of age was different for ILDKT recipients compared to 17,542 CLDKT recipients, we used an interaction term to determine whether the relationship between post-transplant outcomes and transplant type (ILDKT vs. CLDKT) was modified by age. Overall, older recipients had higher mortality (HR: _1.632.07_2.65, p<0.001), lower DCGF (HR: _0.360.53_0.77, p=0.001) and AR (OR: _0.390.54_0.74, p<0.001), and similar DGF (OR: _0.461.03_2.33, p=0.9) and LOS (IRR: _0.880.98_1.10, p=0.8) compared to younger recipients. The impact of age on mortality (interaction p=0.052), DCGF (interaction p=0.7), AR interaction p=0.2), DGF (interaction p=0.9), and LOS (interaction p=0.5) was similar in ILDKT and CLDKT recipients. Age alone should not preclude eligibility for ILDKT.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons Journal