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. 2019 Jan 28;4(5):656-666.
doi: 10.1016/j.ekir.2019.01.014. eCollection 2019 May.

Risk Factors for Early Graft Failure and Death After Kidney Transplantation in Recipients Older Than 70 Years

Mathilde Lemoine  1 , Dimitri Titeca Beauport  2 , Thierry Lobbedez  3 , Gabriel Choukroun  4 , Bruno Hurault de Ligny  3 , Marc Hazzan  5 , Dominique Guerrot  1   6 , Dominique Bertrand  1
Affiliations

Risk Factors for Early Graft Failure and Death After Kidney Transplantation in Recipients Older Than 70 Years

Mathilde Lemoine et al. Kidney Int Rep. .

Abstract

Introduction: Although kidney transplantation carries a survival benefit compared with dialysis, mortality, especially the first year after transplantation, is high in recipients older than 70. The aim of this study was to evaluate early death and graft failure, and to determine the risk factors associated with these events in this specific population.

Methods: All patients older than 70 years who received a kidney transplant between January 2000 and December 2014 in the North-West of France were included (n = 171). Baseline characteristics and outcomes after transplantation were studied. Kaplan-Meier analysis was performed to assess patient and graft survival, and Cox regression analysis to evaluate risk factors for graft failure and patient death.

Results: The mean recipient age was 73.3 ± 2.5 years. Death-censored graft survival at 1, 3, and 5 years were 82.6%, 78.7%, and 75.4%, respectively. Patient survival at 1, 3, and 5 years was 90.1%, 82.5%, and 68.1%, respectively. One year after transplantation, 17 patients (9.9%) were dead, mainly from infectious (58.5%) or cardiovascular disease (29.4%). According to the Cox multivariate analysis, the independent risk factors for death or graft failure during the first year were arrhythmia (odds ratio [OR] 2.26; 95% confidence interval [CI] 1.08-4.8), left-ventricular ejection fraction (LVEF) under 56% (OR 2.38; 95% CI 1.18-4.83), human leucocyte antigen (HLA) antibodies (OR 2.1; 95% CI 1.04-4.2), deceased donor from cardiovascular cause (OR 5.18; 95% CI 1.22-6.3), and acute rejection (OR 2.77; 95% CI 1.2-6.3).

Conclusion: In kidney transplant recipients older than 70 years, cardiac evaluation and immunosuppression optimization seem to be crucial to improve short-term patient and graft survival.

Keywords: cardiovascular disease; elderly; graft failure; infectious disease; kidney transplantation; patient death.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Number of annual kidney transplantations in patients older than 70 during the study period.
Figure 2
Figure 2
Patient survival rates following kidney transplantation in recipients older than 70 years.
Figure 3
Figure 3
Death-censored graft survival rates following kidney transplantation in recipients older than 70 years.
See this image and copyright information in PMC

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